Healthcare Provider Details

I. General information

NPI: 1407512494
Provider Name (Legal Business Name): DEBRE KERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 ELLICOTT ST
BUFFALO NY
14209-2324
US

IV. Provider business mailing address

495 N ATLANTA AVE
N MASSAPEQUA NY
11758-2013
US

V. Phone/Fax

Practice location:
  • Phone: 508-979-5557
  • Fax:
Mailing address:
  • Phone: 516-582-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number091222
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: