Provider Demographics
NPI:1831637164
Name:CINQUANTA, DESIRAE (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:DESIRAE
Middle Name:
Last Name:CINQUANTA
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1114
Mailing Address - Country:US
Mailing Address - Phone:781-322-4861
Mailing Address - Fax:
Practice Address - Street 1:133 SALEM ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1114
Practice Address - Country:US
Practice Address - Phone:781-322-4861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist