Provider Demographics
NPI:1043352826
Name:RICOTTA, GENNA MICHELE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GENNA
Middle Name:MICHELE
Last Name:RICOTTA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 36TH ST APT C6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3753
Mailing Address - Country:US
Mailing Address - Phone:410-960-9372
Mailing Address - Fax:
Practice Address - Street 1:220 E 36TH ST APT C6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3753
Practice Address - Country:US
Practice Address - Phone:410-960-9372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016418-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016418-1OtherSLP LICENSE