Provider Demographics
NPI:1548692379
Name:HARE, BRIANNA R (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:R
Last Name:HARE
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 1:9 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2238
Mailing Address - Country:US
Mailing Address - Phone:516-582-5648
Mailing Address - Fax:
Practice Address - Street 1:9 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2238
Practice Address - Country:US
Practice Address - Phone:516-582-5648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-03
Last Update Date:2013-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist