Provider Demographics
NPI:1437285889
Name:FAVERIO, BRENDA JANE (MS,CCC,LSP)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JANE
Last Name:FAVERIO
Suffix:
Gender:F
Credentials:MS,CCC,LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 NEW MILL RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3350
Mailing Address - Country:US
Mailing Address - Phone:631-979-2089
Mailing Address - Fax:
Practice Address - Street 1:29 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5612
Practice Address - Country:US
Practice Address - Phone:631-499-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007221-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist