Provider Demographics
NPI:1760794390
Name:DI BARTOLOMEO, MARYANN (TSSH)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:DI BARTOLOMEO
Suffix:
Gender:F
Credentials:TSSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 W WINDSOR PKWY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2932
Mailing Address - Country:US
Mailing Address - Phone:516-255-3785
Mailing Address - Fax:
Practice Address - Street 1:239 W WINDSOR PKWY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2932
Practice Address - Country:US
Practice Address - Phone:516-255-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY903555991235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist