Provider Demographics
NPI:1003909474
Name:TRENTACOSTE, LORI (AUD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:TRENTACOSTE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SCHWAB RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1130
Mailing Address - Country:US
Mailing Address - Phone:631-271-1018
Mailing Address - Fax:631-271-1782
Practice Address - Street 1:1 SCHWAB RD STE 3
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1130
Practice Address - Country:US
Practice Address - Phone:631-271-1018
Practice Address - Fax:631-271-1782
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1009231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01760250Medicaid
NY01760250Medicaid