Provider Demographics
NPI:1568758233
Name:CUOMO, ELISABETH ETA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:ETA
Last Name:CUOMO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 MONROE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6399
Mailing Address - Country:US
Mailing Address - Phone:908-868-6245
Mailing Address - Fax:
Practice Address - Street 1:815 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2919
Practice Address - Country:US
Practice Address - Phone:201-823-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00585100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist