Provider Demographics
NPI:1386950152
Name:YEVIN, JUDITH CARLA (MSMA)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:CARLA
Last Name:YEVIN
Suffix:
Gender:F
Credentials:MSMA
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:CARLA
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAMS
Mailing Address - Street 1:27 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2024
Mailing Address - Country:US
Mailing Address - Phone:516-776-1559
Mailing Address - Fax:
Practice Address - Street 1:27 BAYSIDE DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2024
Practice Address - Country:US
Practice Address - Phone:516-466-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTSSH235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist