Provider Demographics
NPI:1396887915
Name:HERBERT, JUDITH L (MACCC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:L
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3058
Mailing Address - Country:US
Mailing Address - Phone:516-785-3136
Mailing Address - Fax:
Practice Address - Street 1:3450 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3058
Practice Address - Country:US
Practice Address - Phone:516-785-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist