Provider Demographics
NPI:1720543515
Name:LARICCIA, KRISTA (MS SLP-CFY)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:LARICCIA
Suffix:
Gender:F
Credentials:MS SLP-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7119 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1438
Mailing Address - Country:US
Mailing Address - Phone:718-683-0879
Mailing Address - Fax:
Practice Address - Street 1:7119 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1438
Practice Address - Country:US
Practice Address - Phone:718-683-0879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist