Provider Demographics
NPI:1841569910
Name:SEARS, LILLIAN WRIGHT (MA CCC-SP)
Entity Type:Individual
Prefix:MRS
First Name:LILLIAN
Middle Name:WRIGHT
Last Name:SEARS
Suffix:
Gender:F
Credentials:MA CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 PORT WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3016
Mailing Address - Country:US
Mailing Address - Phone:516-883-6048
Mailing Address - Fax:
Practice Address - Street 1:1321 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3016
Practice Address - Country:US
Practice Address - Phone:516-883-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004058-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist