Provider Demographics
NPI:1750683157
Name:ATENIESE, ROSE L (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:L
Last Name:ATENIESE
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:MS
Other - First Name:ROSE
Other - Middle Name:L
Other - Last Name:ATENIESE-STEINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 ROUTE 111 UNIT 971
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-7039
Mailing Address - Country:US
Mailing Address - Phone:516-410-5112
Mailing Address - Fax:
Practice Address - Street 1:2025 74TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKYLN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:516-410-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019537-1235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist