Provider Demographics
NPI:1447797634
Name:JOSEPH, NAOMI MYRA (MS,CCC-SLP,SBL,SDL)
Entity type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:MYRA
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MS,CCC-SLP,SBL,SDL
Other - Prefix:
Other - First Name:NAOMI
Other - Middle Name:
Other - Last Name:BRENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1307 CENTRAL AVENUE
Mailing Address - Street 2:P 256 @ 253 Q
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-327-8349
Mailing Address - Fax:
Practice Address - Street 1:1307 CENTRAL AVENUE
Practice Address - Street 2:P 256 @ 253 Q
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-327-8349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist