Provider Demographics
NPI:1710139753
Name:GOLDSTEIN, AMY GROSSMAN (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:GROSSMAN
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 WILLIAMS CT
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-4804
Mailing Address - Country:US
Mailing Address - Phone:516-783-1563
Mailing Address - Fax:
Practice Address - Street 1:2515 WILLIAMS CT
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-4804
Practice Address - Country:US
Practice Address - Phone:516-783-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003374-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist