Provider Demographics
NPI:1780960427
Name:COYNE, BERNADETTE ANN (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:ANN
Last Name:COYNE
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 COOPER STREET
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547
Mailing Address - Country:US
Mailing Address - Phone:914-743-1346
Mailing Address - Fax:
Practice Address - Street 1:3641 COOPER STREET
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547
Practice Address - Country:US
Practice Address - Phone:914-743-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015620-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist