Provider Demographics
NPI:1851608269
Name:SMALL, BEVIN O'BRIEN (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:BEVIN
Middle Name:O'BRIEN
Last Name:SMALL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 E 33RD ST
Mailing Address - Street 2:APT 4J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5338
Mailing Address - Country:US
Mailing Address - Phone:908-902-3556
Mailing Address - Fax:
Practice Address - Street 1:20 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-6302
Practice Address - Country:US
Practice Address - Phone:908-902-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015915-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist