Provider Demographics
NPI:1891148136
Name:TITO, MONICA J (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:J
Last Name:TITO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4196 GLEANE ST
Mailing Address - Street 2:APT.D8
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4196 GLEANE ST
Practice Address - Street 2:APT.D8
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-2669
Practice Address - Country:US
Practice Address - Phone:347-301-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027534-1235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist