Provider Demographics
NPI:1427390046
Name:REFANO, ALISSA JOY (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:JOY
Last Name:REFANO
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BEACON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1350
Mailing Address - Country:US
Mailing Address - Phone:718-207-4776
Mailing Address - Fax:
Practice Address - Street 1:17 BEACON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1350
Practice Address - Country:US
Practice Address - Phone:718-207-4776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022400-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist