Provider Demographics
NPI:1184970485
Name:FRANZESE, JESSICA (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:FRANZESE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:DIMARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:16035 96TH ST
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3806
Mailing Address - Country:US
Mailing Address - Phone:347-865-7007
Mailing Address - Fax:
Practice Address - Street 1:5700 223RD ST
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1936
Practice Address - Country:US
Practice Address - Phone:347-865-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022951235Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03762549Medicaid