Provider Demographics
NPI:1770735342
Name:FISCHETTI, MICHELE (MS, CCC-SLP, NYS/L)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:FISCHETTI
Suffix:
Gender:F
Credentials:MS, CCC-SLP, NYS/L
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:SCOTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP, NYS/L
Mailing Address - Street 1:109 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1305
Mailing Address - Country:US
Mailing Address - Phone:732-972-1464
Mailing Address - Fax:732-972-1464
Practice Address - Street 1:3450 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6721
Practice Address - Country:US
Practice Address - Phone:718-447-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009009-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist