Provider Demographics
NPI:1508010307
Name:DECICCO, PATRICIA ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:DECICCO
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 1:12 HAMLET CT
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4463
Mailing Address - Country:US
Mailing Address - Phone:845-297-2905
Mailing Address - Fax:
Practice Address - Street 1:12 HAMLET CT
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4463
Practice Address - Country:US
Practice Address - Phone:845-297-2905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015363-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist