Provider Demographics
NPI:1255877478
Name:CALVOSA, PATRICIA ROSE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ROSE
Last Name:CALVOSA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BUCKNELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730
Mailing Address - Country:US
Mailing Address - Phone:646-284-6081
Mailing Address - Fax:
Practice Address - Street 1:20 BUCKNELL DR
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-2304
Practice Address - Country:US
Practice Address - Phone:646-284-6081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00820300235Z00000X
NY025032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist