Healthcare Provider Details

I. General information

NPI: 1871984625
Provider Name (Legal Business Name): LAURA GREENSTEIN CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA BENNETT M.A. CCC-SLP

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 EVERETT DR
YAPHANK NY
11980-9633
US

IV. Provider business mailing address

45 COLLEGE HILLS DR
FARMINGVILLE NY
11738-1449
US

V. Phone/Fax

Practice location:
  • Phone: 631-345-2173
  • Fax:
Mailing address:
  • Phone: 631-345-2750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number024262
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: