Provider Demographics
NPI:1669781076
Name:RAMOS, MARISSA LYNN (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:RAMOS
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 TALLMAN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4818
Mailing Address - Country:US
Mailing Address - Phone:718-948-1382
Mailing Address - Fax:
Practice Address - Street 1:120 RATHBUN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3006
Practice Address - Country:US
Practice Address - Phone:781-948-8879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-03
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014219235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist