Provider Demographics
NPI:1003294711
Name:BARBARA, ALEXIS R (MS, TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:R
Last Name:BARBARA
Suffix:
Gender:F
Credentials:MS, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3205
Mailing Address - Country:US
Mailing Address - Phone:718-317-1414
Mailing Address - Fax:
Practice Address - Street 1:493 GENESEE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3205
Practice Address - Country:US
Practice Address - Phone:718-317-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024080-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist