Provider Demographics
NPI:1629219431
Name:NICOSIA-BRITTON, ELIZABETH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NICOSIA-BRITTON
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 1:185 COUNTY ROUTE 359
Mailing Address - Street 2:
Mailing Address - City:RENSSELAERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12147-2213
Mailing Address - Country:US
Mailing Address - Phone:518-797-3557
Mailing Address - Fax:
Practice Address - Street 1:185 COUNTY ROUTE 359
Practice Address - Street 2:
Practice Address - City:RENSSELAERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12147-2213
Practice Address - Country:US
Practice Address - Phone:518-797-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012206-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist