Provider Demographics
NPI:1528307105
Name:BENNINGTON, PAIGE D (MS)
Entity type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:D
Last Name:BENNINGTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:PAIGE
Other - Middle Name:D
Other - Last Name:BERKOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:661 SACKETT ST
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3131
Mailing Address - Country:US
Mailing Address - Phone:914-274-0880
Mailing Address - Fax:
Practice Address - Street 1:661 SACKETT ST
Practice Address - Street 2:APT 2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3131
Practice Address - Country:US
Practice Address - Phone:914-274-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist