Provider Demographics
NPI:1730965880
Name:DEBEER GRUVMAN, EDNA TAMAR (LCAT)
Entity type:Individual
Prefix:MS
First Name:EDNA
Middle Name:TAMAR
Last Name:DEBEER GRUVMAN
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 COURT ST APT 21
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4348
Mailing Address - Country:US
Mailing Address - Phone:631-553-7284
Mailing Address - Fax:
Practice Address - Street 1:15 SHOREHAM DR W
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6580
Practice Address - Country:US
Practice Address - Phone:631-553-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000142-01225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist