Provider Demographics
NPI:1407124167
Name:GREEN, ZAHAVA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ZAHAVA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:ZAHAVA
Other - Middle Name:
Other - Last Name:KOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1049 38TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1012
Mailing Address - Country:US
Mailing Address - Phone:718-633-6666
Mailing Address - Fax:718-633-5331
Practice Address - Street 1:1049 38TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1012
Practice Address - Country:US
Practice Address - Phone:718-633-6666
Practice Address - Fax:718-633-5331
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021493235Z00000X
NJ41Y500654300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist