Individual
DR. DEBRA DIANNE DOMENECH-RISTORUCCI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1842 21ST RD, ASTORIA, NY 11105-3940
(917) 698-2902
Mailing address
1842 21ST RD, ASTORIA, NY 11105-3940
(917) 698-2902
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
010007
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010007
PSYCHOLOGIST LICENSE
NY
Enumeration date
03/10/2021
Last updated
03/10/2021
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