Healthcare Provider Details

I. General information

NPI: 1437588621
Provider Name (Legal Business Name): DEBRA BASHIST PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 AYERS CT STE LLA 1
TEANECK NJ
07666-5171
US

IV. Provider business mailing address

668 PASSAIC AVE
CLIFTON NJ
07012-1827
US

V. Phone/Fax

Practice location:
  • Phone: 646-671-6239
  • Fax:
Mailing address:
  • Phone: 646-671-6239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00511300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number35SI00511300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: