Provider Demographics
NPI:1083035265
Name:GOLUB, STEPHANIE ELLEN (MA CCC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:GOLUB
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1707
Mailing Address - Country:US
Mailing Address - Phone:718-498-2500
Mailing Address - Fax:718-778-4018
Practice Address - Street 1:567 KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1707
Practice Address - Country:US
Practice Address - Phone:718-498-2500
Practice Address - Fax:718-778-4018
Is Sole Proprietor?:No
Enumeration Date:2013-12-14
Last Update Date:2013-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist