Provider Demographics
NPI:1710282470
Name:DICARLO, ANDREA C (CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:C
Last Name:DICARLO
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 1:6170 DOE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-1153
Mailing Address - Country:US
Mailing Address - Phone:585-742-3118
Mailing Address - Fax:
Practice Address - Street 1:6170 DOE HAVEN DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-1153
Practice Address - Country:US
Practice Address - Phone:585-742-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006980-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006980-1OtherNY STATE LICENSE SPEECH LANGUAGE PATHOLOGY