Provider Demographics
NPI:1891437554
Name:GIAMBALVO-GROSSO, MARYANN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:
Last Name:GIAMBALVO-GROSSO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-3228
Mailing Address - Country:US
Mailing Address - Phone:631-332-8224
Mailing Address - Fax:
Practice Address - Street 1:1476 14TH ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-3228
Practice Address - Country:US
Practice Address - Phone:631-332-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008088235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY008088OtherSPEECH AND LANGUAGE PATHOLOGY