Provider Demographics
NPI:1114150125
Name:STEIN, SANDRA J (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:STEIN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:J
Other - Last Name:GOLDBERG-STEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC /SLP
Mailing Address - Street 1:9502 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5320
Mailing Address - Country:US
Mailing Address - Phone:718-251-2590
Mailing Address - Fax:718-251-2590
Practice Address - Street 1:9502 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5320
Practice Address - Country:US
Practice Address - Phone:718-251-2590
Practice Address - Fax:718-251-2590
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist