Provider Demographics
NPI:1639455538
Name:TOMMASINO, NANCY BETH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BETH
Last Name:TOMMASINO
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 1:69 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11715-1040
Mailing Address - Country:US
Mailing Address - Phone:631-363-7523
Mailing Address - Fax:
Practice Address - Street 1:320 BEACH 104TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2782
Practice Address - Country:US
Practice Address - Phone:718-474-6918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist