Provider Demographics
NPI:1487963682
Name:AVALLONE-BALFOUR, LYDIA A (MA/CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:A
Last Name:AVALLONE-BALFOUR
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:A
Other - Last Name:AVALLONE-HARTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA/CCC-SLP
Mailing Address - Street 1:4 MIKE LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2327
Mailing Address - Country:US
Mailing Address - Phone:631-697-7553
Mailing Address - Fax:
Practice Address - Street 1:299 HALLOCK AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1217
Practice Address - Country:US
Practice Address - Phone:631-473-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003114-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist