Provider Demographics
NPI:1073767166
Name:COSME, IVETTE (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:
Last Name:COSME
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5149
Mailing Address - Country:US
Mailing Address - Phone:917-640-4138
Mailing Address - Fax:203-386-0440
Practice Address - Street 1:434 ERWIN ST
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5149
Practice Address - Country:US
Practice Address - Phone:917-640-4138
Practice Address - Fax:203-386-0440
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist