Provider Demographics
NPI:1922144559
Name:BALLOSINGH-PICARD, ANNA MARY LAUREN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARY LAUREN
Last Name:BALLOSINGH-PICARD
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:15 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740
Mailing Address - Country:US
Mailing Address - Phone:631-262-0113
Mailing Address - Fax:631-262-0113
Practice Address - Street 1:15 BROADWAY
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740
Practice Address - Country:US
Practice Address - Phone:631-262-0113
Practice Address - Fax:631-262-0113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061533-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist