Provider Demographics
NPI:1598019721
Name:CHILDREN'S SPEECH AND REHABILITATION THERAPY, AND SPEECH-LANGUAGE PATH
Entity Type:Organization
Organization Name:CHILDREN'S SPEECH AND REHABILITATION THERAPY, AND SPEECH-LANGUAGE PATH
Other - Org Name:CHILDREN'S SPEECH AND REHABILITATION THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:516-827-1970
Mailing Address - Street 1:191 FOREST AVE UNIT 2B
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2143
Mailing Address - Country:US
Mailing Address - Phone:516-827-1970
Mailing Address - Fax:516-827-0035
Practice Address - Street 1:191 FOREST AVE UNIT 2B
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2143
Practice Address - Country:US
Practice Address - Phone:516-827-1970
Practice Address - Fax:516-827-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management