Provider Demographics
NPI:1033368550
Name:GRITTINI, MARISA LEE (AUD)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:LEE
Last Name:GRITTINI
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 1:15 OLD KATONAH DRIVE
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536
Mailing Address - Country:US
Mailing Address - Phone:630-379-2821
Mailing Address - Fax:
Practice Address - Street 1:227 MADISON STREET
Practice Address - Street 2:GOUVERNEUR HOSPITAL (DEPT OF REHAB SERVICES)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-238-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2014-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000649231H00000X
NY002564231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist