Provider Demographics
NPI:1811136500
Name:SONNENBLICK, DINA (OTR/L)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:SONNENBLICK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 OCEAN PARKWAY
Mailing Address - Street 2:APT. 6K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 4TH AVE
Practice Address - Street 2:PS 172
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-1701
Practice Address - Country:US
Practice Address - Phone:718-965-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013008-1251300000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency