Provider Demographics
NPI:1184992117
Name:CARBONARO, ASHLEY (MS)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:CARBONARO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 3RD AVE APT 503
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4340
Mailing Address - Country:US
Mailing Address - Phone:631-944-2357
Mailing Address - Fax:
Practice Address - Street 1:8725 136TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1924
Practice Address - Country:US
Practice Address - Phone:718-291-2807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021518-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist