Provider Demographics
NPI:1457809220
Name:MESSANO, LISAMARIE RICIGLIANO (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:LISAMARIE
Middle Name:RICIGLIANO
Last Name:MESSANO
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 TIDEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8428
Mailing Address - Country:US
Mailing Address - Phone:516-996-6950
Mailing Address - Fax:
Practice Address - Street 1:99 TIDEWATER AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-8428
Practice Address - Country:US
Practice Address - Phone:516-996-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026085-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist