Provider Demographics
NPI:1730496779
Name:LICATA COUSSA, LINDA (MS)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:LICATA COUSSA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107A 73RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1903
Mailing Address - Country:US
Mailing Address - Phone:646-279-9700
Mailing Address - Fax:718-745-0504
Practice Address - Street 1:107A 73RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1903
Practice Address - Country:US
Practice Address - Phone:646-279-9700
Practice Address - Fax:718-745-0504
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY464652237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist