Provider Demographics
NPI:1255694006
Name:DIBENEDETTO, ALLISON ANN (MA, CCC-SLP TSHH)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ANN
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:MA, CCC-SLP TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14632 WILLETS POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3543
Mailing Address - Country:US
Mailing Address - Phone:516-263-8797
Mailing Address - Fax:
Practice Address - Street 1:189 WHEATLEY ROAD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:NY
Practice Address - Zip Code:11545-2699
Practice Address - Country:US
Practice Address - Phone:516-626-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013035-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist