Healthcare Provider Details

I. General information

NPI: 1386440899
Provider Name (Legal Business Name): DEBORAH LORISSAINT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 SOUTHERN BLVD
BRONX NY
10460-6262
US

IV. Provider business mailing address

30 NOYES AVE
SPRING VALLEY NY
10977-5739
US

V. Phone/Fax

Practice location:
  • Phone: 718-365-4044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number852360
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number852360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: