Provider Demographics
NPI:1760717201
Name:ERNECOFF, CAROLINE LOUISE (MS, SLP-CCC, TSSLD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:LOUISE
Last Name:ERNECOFF
Suffix:
Gender:F
Credentials:MS, SLP-CCC, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:589 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782
Mailing Address - Country:US
Mailing Address - Phone:631-567-1609
Mailing Address - Fax:
Practice Address - Street 1:589 SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-3322
Practice Address - Country:US
Practice Address - Phone:631-567-1609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12134936235Z00000X
NY019126-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist