Provider Demographics
NPI:1770611501
Name:OLIVER, CARYN F (MS,CCC,SLP)
Entity type:Individual
Prefix:MRS
First Name:CARYN
Middle Name:F
Last Name:OLIVER
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 1:40 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3643
Mailing Address - Country:US
Mailing Address - Phone:631-691-6560
Mailing Address - Fax:
Practice Address - Street 1:40 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3643
Practice Address - Country:US
Practice Address - Phone:631-691-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008493-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist