Provider Demographics
NPI:1942448386
Name:MITZMANN, LAURA (MA, CCC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MITZMANN
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GOLAR DR
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2845
Mailing Address - Country:US
Mailing Address - Phone:845-369-8701
Mailing Address - Fax:845-369-8759
Practice Address - Street 1:6 GOLAR DR
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2845
Practice Address - Country:US
Practice Address - Phone:845-369-8701
Practice Address - Fax:845-369-8759
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003597-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist