Provider Demographics
NPI:1528210580
Name:DOWLAT-CORBANESE, LORETTA KARI
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:KARI
Last Name:DOWLAT-CORBANESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:KARI
Other - Last Name:DOWLAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 ELLWOOD AVE
Mailing Address - Street 2:APT. 2F
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3448
Mailing Address - Country:US
Mailing Address - Phone:914-297-2292
Mailing Address - Fax:
Practice Address - Street 1:101 ELLWOOD AVE
Practice Address - Street 2:APT. 2F
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3448
Practice Address - Country:US
Practice Address - Phone:914-297-2292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016728-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist