Provider Demographics
NPI:1972930618
Name:WACKSMAN- BINDER, LORI BETH (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:BETH
Last Name:WACKSMAN- BINDER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1238
Mailing Address - Country:US
Mailing Address - Phone:845-942-7953
Mailing Address - Fax:
Practice Address - Street 1:65 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1238
Practice Address - Country:US
Practice Address - Phone:845-942-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010326-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist