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General NPI Number Information
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NPI Number | 1730965880
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Entity Type | Individual
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Provider Name | EDNA TAMAR DEBEER GRUVMAN LCAT
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Gender | Female
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 15 SHOREHAM DR W
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City | DIX HILLS
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State | NY
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Zip | 11746-6580
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Country | US
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Telephone | 631-553-7284
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Fax |
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Provider Business Mailing Address
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Address Line | 360 COURT ST APT 21
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City | BROOKLYN
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State | NY
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Zip | 11231-4348
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Country | US
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Telephone | 631-553-7284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number | 000142-01
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License Number State | NY
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