Provider Demographics
NPI:1326301623
Name:KOVAC, LISA BARONE (MA,CCC,SLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BARONE
Last Name:KOVAC
Suffix:
Gender:F
Credentials:MA,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOYT RD
Mailing Address - Street 2:
Mailing Address - City:POUND RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10576-1417
Mailing Address - Country:US
Mailing Address - Phone:914-764-5485
Mailing Address - Fax:
Practice Address - Street 1:1000 WEST BOSTON POST ROAD
Practice Address - Street 2:MAMARONECK UNION FREE SCHOOL DISTRICT
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-220-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004079-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist