Provider Demographics
NPI:1386954519
Name:HAVEL-BRUNO, LYNN (MS)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:HAVEL-BRUNO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHANTICLEER DR
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-4519
Mailing Address - Country:US
Mailing Address - Phone:631-650-0707
Mailing Address - Fax:
Practice Address - Street 1:18 CHANTICLEER DR
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-4519
Practice Address - Country:US
Practice Address - Phone:631-650-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003292-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist