Provider Demographics
NPI:1326272402
Name:ROCCO, TINA M (MA CCC-SLP, HPCS)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:ROCCO
Suffix:
Gender:F
Credentials:MA CCC-SLP, HPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 OLD NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5004
Mailing Address - Country:US
Mailing Address - Phone:631-479-3393
Mailing Address - Fax:
Practice Address - Street 1:300 WHEELER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4300
Practice Address - Country:US
Practice Address - Phone:631-479-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018512235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist