Provider Demographics
NPI:1760149173
Name:GAROFALO, ROCKY WILLIAM ANTHONY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROCKY
Middle Name:WILLIAM ANTHONY
Last Name:GAROFALO
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SHEARIN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1847
Mailing Address - Country:US
Mailing Address - Phone:315-877-4516
Mailing Address - Fax:
Practice Address - Street 1:725 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2395
Practice Address - Country:US
Practice Address - Phone:315-435-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY031365OtherSTATE LICENSE