Provider Demographics
NPI:1013221340
Name:MATTABONI, LAURIE A (MS CCC)
Entity Type:Individual
Prefix:MISS
First Name:LAURIE
Middle Name:A
Last Name:MATTABONI
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-2436
Mailing Address - Country:US
Mailing Address - Phone:914-907-5708
Mailing Address - Fax:
Practice Address - Street 1:10 NEW KING ST
Practice Address - Street 2:105
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-1205
Practice Address - Country:US
Practice Address - Phone:914-390-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0199031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist