Provider Demographics
NPI:1386850139
Name:DICRISTOFARO, DENISE
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:DICRISTOFARO
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 1:555 BROADWAY
Mailing Address - Street 2:SPEECH AND HEARING CENTER RM G16
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522
Mailing Address - Country:US
Mailing Address - Phone:914-674-7739
Mailing Address - Fax:914-674-7597
Practice Address - Street 1:555 BROADWAY
Practice Address - Street 2:SPEECH AND HEARING CENTER RM G16
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522
Practice Address - Country:US
Practice Address - Phone:914-674-7742
Practice Address - Fax:914-674-7597
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist