Provider Demographics
NPI:1801031901
Name:GOLDEN, LORI MICHELLE (MA-CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:MICHELLE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:MA-CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:320 E 65TH ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6743
Mailing Address - Country:US
Mailing Address - Phone:212-249-2588
Mailing Address - Fax:212-249-2594
Practice Address - Street 1:320 E 65TH ST
Practice Address - Street 2:SUITE 117
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6743
Practice Address - Country:US
Practice Address - Phone:212-249-2588
Practice Address - Fax:212-249-2594
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009941-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist