Provider Demographics
NPI:1760622500
Name:COSENTINO, ALYSSA EMILY
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:EMILY
Last Name:COSENTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:EMILY
Other - Last Name:HILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 SOUTHALL LN
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5761
Mailing Address - Country:US
Mailing Address - Phone:201-321-0695
Mailing Address - Fax:
Practice Address - Street 1:950 ROUTE 36
Practice Address - Street 2:
Practice Address - City:LEONARDO
Practice Address - State:NJ
Practice Address - Zip Code:07737
Practice Address - Country:US
Practice Address - Phone:732-639-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2018-06-15
Deactivation Date:2010-04-16
Deactivation Code:
Reactivation Date:2010-05-17
Provider Licenses
StateLicense IDTaxonomies
PASL009147235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist