Provider Demographics
NPI:1760524227
Name:SMITH, LYNN GOLDBERG (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:GOLDBERG
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:FRANCENE
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCCSLP
Mailing Address - Street 1:1 SUNSET HLS
Mailing Address - Street 2:FRANKLIN STREET
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2883
Mailing Address - Country:US
Mailing Address - Phone:631-543-2238
Mailing Address - Fax:
Practice Address - Street 1:9 SMITHS LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3510
Practice Address - Country:US
Practice Address - Phone:631-543-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004019-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist