Provider Demographics
NPI:1265743249
Name:BRAVSTEIN, LINDA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BRAVSTEIN
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 1:59 CRESTHOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1046
Mailing Address - Country:US
Mailing Address - Phone:516-625-1725
Mailing Address - Fax:
Practice Address - Street 1:59 CRESTHOLLOW LN
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1046
Practice Address - Country:US
Practice Address - Phone:516-625-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002434-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist