Provider Demographics
NPI:1780130724
Name:MATHEW, TRESA (MSED CF-SLP)
Entity type:Individual
Prefix:
First Name:TRESA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MSED CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 ETON ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2407
Mailing Address - Country:US
Mailing Address - Phone:347-449-3569
Mailing Address - Fax:
Practice Address - Street 1:8520 ETON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2407
Practice Address - Country:US
Practice Address - Phone:347-449-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist