Provider Demographics
NPI:1255628970
Name:CARBONE, STEPHANIE JILL (MS ED CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JILL
Last Name:CARBONE
Suffix:
Gender:F
Credentials:MS ED CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WOODBURY HL
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-2926
Mailing Address - Country:US
Mailing Address - Phone:518-283-1245
Mailing Address - Fax:
Practice Address - Street 1:1 EAST AVENUE
Practice Address - Street 2:GARDNER DICKINSON SCHOOL
Practice Address - City:WYNANTSKILL
Practice Address - State:NY
Practice Address - Zip Code:12198
Practice Address - Country:US
Practice Address - Phone:518-283-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012381-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist