Provider Demographics
NPI:1518249598
Name:CARACCIOLO, ALECIA L (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:ALECIA
Middle Name:L
Last Name:CARACCIOLO
Suffix:
Gender:F
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 1:999 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-7205
Mailing Address - Country:US
Mailing Address - Phone:607-757-2143
Mailing Address - Fax:
Practice Address - Street 1:999 TAFT AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-7205
Practice Address - Country:US
Practice Address - Phone:607-757-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021165-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist