Provider Demographics
NPI:1790093656
Name:CUCCIO, TRICIA MICHELLE (MA, CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:MICHELLE
Last Name:CUCCIO
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4325
Mailing Address - Country:US
Mailing Address - Phone:516-561-3841
Mailing Address - Fax:
Practice Address - Street 1:135 ELMONT RD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1635
Practice Address - Country:US
Practice Address - Phone:516-322-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016925-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist