Provider Demographics
NPI:1033406863
Name:MASSARO, TRACY LYNN (MS SLP TSLD)
Entity Type:Individual
Prefix:MISS
First Name:TRACY
Middle Name:LYNN
Last Name:MASSARO
Suffix:
Gender:F
Credentials:MS SLP TSLD
Other - Prefix:
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Mailing Address - Street 1:923 N ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2116
Mailing Address - Country:US
Mailing Address - Phone:631-748-6992
Mailing Address - Fax:
Practice Address - Street 1:1767 VETERANS HWY STE 22
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1536
Practice Address - Country:US
Practice Address - Phone:631-851-9486
Practice Address - Fax:631-851-9487
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021063-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist