Provider Demographics
NPI:1700416518
Name:VICCARO, ELIZABETH (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:VICCARO
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:VICCARO
Other - Last Name:SITLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:378 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1125
Mailing Address - Country:US
Mailing Address - Phone:917-572-5834
Mailing Address - Fax:
Practice Address - Street 1:6530 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1597
Practice Address - Country:US
Practice Address - Phone:718-997-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011168235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist