Provider Demographics
NPI:1336486711
Name:PRINCE-BAREN, ROBIN (CCC/LSP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:PRINCE-BAREN
Suffix:
Gender:F
Credentials:CCC/LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 JILL DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-1786
Mailing Address - Country:US
Mailing Address - Phone:516-810-4763
Mailing Address - Fax:631-544-0042
Practice Address - Street 1:19 JILL DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-1786
Practice Address - Country:US
Practice Address - Phone:516-810-4763
Practice Address - Fax:631-544-0042
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-06
Last Update Date:2013-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005086-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist