Provider Demographics
NPI:1598944639
Name:DRESHER, CARYL ROBIN (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:CARYL ROBIN
Middle Name:
Last Name:DRESHER
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 1:250 CENTRAL AVE
Mailing Address - Street 2:APT. D120
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1544
Mailing Address - Country:US
Mailing Address - Phone:516-668-9071
Mailing Address - Fax:
Practice Address - Street 1:510 DUBOIS AVE
Practice Address - Street 2:APT. 3C
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3230
Practice Address - Country:US
Practice Address - Phone:516-791-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003365-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY003365-1OtherLICENSED SPEECH PATHOLOGI