Provider Demographics
NPI:1437276375
Name:COLAVITA, LEONARDO (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:LEONARDO
Middle Name:
Last Name:COLAVITA
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KEARNY AVE
Mailing Address - Street 2:1A
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-5587
Mailing Address - Country:US
Mailing Address - Phone:973-222-8427
Mailing Address - Fax:
Practice Address - Street 1:15 DELLWOOD LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1551
Practice Address - Country:US
Practice Address - Phone:732-545-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00494900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist