Individual
MRS. TINA O'BRIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC/SLP
Contact information
Practice address
50 VAN COTT AVE, FARMINGDALE, NY 11735-3743
(516) 752-6575
Mailing address
360 OCEAN AVE, MASSAPEQUA PARK, NY 11762-1622
(516) 752-6575
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01435749
—
NY
Enumeration date
09/20/2012
Last updated
09/20/2012
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