Provider Demographics
NPI:1538727490
Name:RUBENSTEIN, GENNA S (MA CCC-SLP, TSSLD)
Entity type:Individual
Prefix:
First Name:GENNA
Middle Name:S
Last Name:RUBENSTEIN
Suffix:
Gender:F
Credentials:MA CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WESTBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3305
Mailing Address - Country:US
Mailing Address - Phone:484-796-1988
Mailing Address - Fax:
Practice Address - Street 1:12 WESTBOURNE LN
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3305
Practice Address - Country:US
Practice Address - Phone:484-796-1988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist