Provider Demographics
NPI:1205940624
Name:DE LA TORRE, ELIZABETH A (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:MERKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:507 W 169TH ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4011
Mailing Address - Country:US
Mailing Address - Phone:786-554-2871
Mailing Address - Fax:
Practice Address - Street 1:1500 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1100
Practice Address - Country:US
Practice Address - Phone:718-730-1004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8512235Z00000X
NY018252-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890563100Medicaid