Provider Demographics
NPI:1245578103
Name:COCCARO, LYNDA R
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:R
Last Name:COCCARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SITTERLY RD
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-5613
Mailing Address - Country:US
Mailing Address - Phone:518-899-9235
Mailing Address - Fax:518-899-9315
Practice Address - Street 1:220 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-1502
Practice Address - Country:US
Practice Address - Phone:518-338-3482
Practice Address - Fax:518-338-3484
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8072235Z00000X
NY003272-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist