Provider Demographics
NPI:1689916413
Name:MARIE LAUTATO CCC SLP , PC
Entity Type:Organization
Organization Name:MARIE LAUTATO CCC SLP , PC
Other - Org Name:ANNIE'S PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUTATO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:917-559-7005
Mailing Address - Street 1:1154 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1306
Mailing Address - Country:US
Mailing Address - Phone:917-559-7005
Mailing Address - Fax:347-497-5743
Practice Address - Street 1:1154 72ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1306
Practice Address - Country:US
Practice Address - Phone:917-559-7005
Practice Address - Fax:347-497-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0135111235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty