Provider Demographics
NPI:1689943029
Name:BENNARDO, LOIS MARY (MS CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:MARY
Last Name:BENNARDO
Suffix:
Gender:F
Credentials:MS CCC-A
Other - Prefix:MISS
Other - First Name:LOIS
Other - Middle Name:MARY
Other - Last Name:GENOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1964
Mailing Address - Country:US
Mailing Address - Phone:516-570-6181
Mailing Address - Fax:
Practice Address - Street 1:325 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2779
Practice Address - Country:US
Practice Address - Phone:631-351-3722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY797-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist