Provider Demographics
NPI:1053447128
Name:ALLISON ANN DIBENEDETTO, MA, SPEECH-LANGUAGE PATHOLOGY, PC
Entity Type:Organization
Organization Name:ALLISON ANN DIBENEDETTO, MA, SPEECH-LANGUAGE PATHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DIBENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP TSHH
Authorized Official - Phone:516-263-8797
Mailing Address - Street 1:14632 WILLETS POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3543
Mailing Address - Country:US
Mailing Address - Phone:516-263-8797
Mailing Address - Fax:
Practice Address - Street 1:14632 WILLETS POINT BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3543
Practice Address - Country:US
Practice Address - Phone:516-263-8797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013035-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty