Provider Demographics
NPI:1790920304
Name:TUSA, MARIA LOUISE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:LOUISE
Last Name:TUSA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LOUISE
Other - Last Name:BLANCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:3 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1507
Mailing Address - Country:US
Mailing Address - Phone:516-592-7428
Mailing Address - Fax:
Practice Address - Street 1:3 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-1507
Practice Address - Country:US
Practice Address - Phone:516-592-7428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist