Provider Demographics
NPI:1811213143
Name:LABOZZETTI BRUGELLIS, GINA ROSE (MS SLP TSHH)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:ROSE
Last Name:LABOZZETTI BRUGELLIS
Suffix:
Gender:F
Credentials:MS SLP TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2411
Mailing Address - Country:US
Mailing Address - Phone:845-741-9381
Mailing Address - Fax:845-294-8785
Practice Address - Street 1:172 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2411
Practice Address - Country:US
Practice Address - Phone:845-741-9381
Practice Address - Fax:845-294-8785
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist