Provider Demographics
NPI:1073641676
Name:LA BARBERA, LISA (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LA BARBERA
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GRETOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:2436 157TH ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3745
Mailing Address - Country:US
Mailing Address - Phone:718-886-0743
Mailing Address - Fax:
Practice Address - Street 1:2436 157TH ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3745
Practice Address - Country:US
Practice Address - Phone:718-886-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009433-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist