Provider Demographics
NPI:1073767513
Name:CANTARA, LISETTE MONTALVO (MSCCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISETTE
Middle Name:MONTALVO
Last Name:CANTARA
Suffix:
Gender:F
Credentials:MSCCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BROMLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5013
Mailing Address - Country:US
Mailing Address - Phone:516-352-3030
Mailing Address - Fax:
Practice Address - Street 1:143 BROMLEIGH RD
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530-5013
Practice Address - Country:US
Practice Address - Phone:516-352-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist