Provider Demographics
NPI:1346556099
Name:LOBRAICO, KRISTEN MARIE (MASLP)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:MARIE
Last Name:LOBRAICO
Suffix:
Gender:F
Credentials:MASLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SHERRI COURT
Mailing Address - Street 2:P.O. BOX 526
Mailing Address - City:SPEONK
Mailing Address - State:NY
Mailing Address - Zip Code:11972
Mailing Address - Country:US
Mailing Address - Phone:631-786-9124
Mailing Address - Fax:
Practice Address - Street 1:1165 NORTHERN BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3048
Practice Address - Country:US
Practice Address - Phone:516-627-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist