Provider Demographics
NPI:1750781134
Name:FREITAS, JUSTINE BARBARA (MA BILCCC-SLP, TSSLD)
Entity type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:BARBARA
Last Name:FREITAS
Suffix:
Gender:F
Credentials:MA BILCCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BORDEN AVE
Mailing Address - Street 2:APT 18F
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-6204
Mailing Address - Country:US
Mailing Address - Phone:718-687-0225
Mailing Address - Fax:
Practice Address - Street 1:7252 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2100
Practice Address - Country:US
Practice Address - Phone:718-326-0055
Practice Address - Fax:718-326-0637
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist