Provider Demographics
NPI:1790504603
Name:DIVERSE VOICES SPEECH LANGUAGE PATHOLOGY PLLC
Entity type:Organization
Organization Name:DIVERSE VOICES SPEECH LANGUAGE PATHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MORILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCC TSLD-BE
Authorized Official - Phone:347-344-4344
Mailing Address - Street 1:221 GODDARD AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2046
Mailing Address - Country:US
Mailing Address - Phone:347-344-4344
Mailing Address - Fax:
Practice Address - Street 1:2151 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2506
Practice Address - Country:US
Practice Address - Phone:347-344-4344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech