Provider Demographics
NPI:1154632370
Name:GOLDSTEIN, AVIVA (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:AVIVA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 JORDAN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2525
Mailing Address - Country:US
Mailing Address - Phone:516-569-0833
Mailing Address - Fax:
Practice Address - Street 1:322 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2525
Practice Address - Country:US
Practice Address - Phone:516-569-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007986-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist