Provider Demographics
NPI:1396095410
Name:GOLDSTEIN, LAUREN BETH (MS, CCC, SLP)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BETH
Last Name:GOLDSTEIN
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 1:28 SHADY TREE LN
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1924
Mailing Address - Country:US
Mailing Address - Phone:631-331-0508
Mailing Address - Fax:631-474-2124
Practice Address - Street 1:28 SHADY TREE LN
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1924
Practice Address - Country:US
Practice Address - Phone:631-331-0508
Practice Address - Fax:631-474-2124
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist