Provider Demographics
NPI:1023325743
Name:BROWN, KRISTIN MAZZEO (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MAZZEO
Last Name:BROWN
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 1:234 HAGERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5581
Mailing Address - Country:US
Mailing Address - Phone:631-730-8723
Mailing Address - Fax:
Practice Address - Street 1:234 HAGERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5581
Practice Address - Country:US
Practice Address - Phone:631-730-8723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017183-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist