Provider Demographics
NPI:1821531302
Name:GORMAN, ERIN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:FABOZZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:15 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1823
Mailing Address - Country:US
Mailing Address - Phone:718-984-9800
Mailing Address - Fax:
Practice Address - Street 1:15 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-1823
Practice Address - Country:US
Practice Address - Phone:718-984-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009094-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist