Provider Demographics
NPI:1851545032
Name:PRIMIS, LAURA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:PRIMIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:DEBLASI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:4821 5TH ST
Mailing Address - Street 2:APT 2I
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5694
Mailing Address - Country:US
Mailing Address - Phone:917-670-0941
Mailing Address - Fax:
Practice Address - Street 1:4821 5TH ST APT 2I
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5695
Practice Address - Country:US
Practice Address - Phone:917-670-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist