Healthcare Provider Details

I. General information

NPI: 1487794343
Provider Name (Legal Business Name): DEBRA SUKHOO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14732 JAMAICA AVE
JAMAICA NY
11435-4042
US

IV. Provider business mailing address

10470 125TH ST
SOUTH RICHMOND HILL NY
11419-2912
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number073309
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: