Provider Demographics
NPI:1083866131
Name:PERRICELLI, CHRISTINE TERESA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:TERESA
Last Name:PERRICELLI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WATERFRONT VIEW
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1214
Mailing Address - Country:US
Mailing Address - Phone:914-528-8123
Mailing Address - Fax:
Practice Address - Street 1:116 WATER FRONT VW
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1214
Practice Address - Country:US
Practice Address - Phone:914-528-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016388-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist