Provider Demographics
NPI:1457652240
Name:BERNICH, CRISTINA MARIE (MS,CCC,SLP)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:MARIE
Last Name:BERNICH
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 1:33 LANDING RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1815
Mailing Address - Country:US
Mailing Address - Phone:631-673-1948
Mailing Address - Fax:
Practice Address - Street 1:33 LANDING RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1815
Practice Address - Country:US
Practice Address - Phone:631-673-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58010494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist