Provider Demographics
NPI:1154864643
Name:CARRERA, MELISSA CRUZ (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CRUZ
Last Name:CARRERA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CARRERA-HEGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:383 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1706
Mailing Address - Country:US
Mailing Address - Phone:718-852-1701
Mailing Address - Fax:718-624-6746
Practice Address - Street 1:383 STATE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1706
Practice Address - Country:US
Practice Address - Phone:718-852-1701
Practice Address - Fax:718-624-6746
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016471235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist