Provider Demographics
NPI:1831324573
Name:ROBATEAU, LISA DIANA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DIANA
Last Name:ROBATEAU
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 RYERSON ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-2543
Mailing Address - Country:US
Mailing Address - Phone:917-523-3113
Mailing Address - Fax:718-622-9322
Practice Address - Street 1:78 RYERSON ST
Practice Address - Street 2:APT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2543
Practice Address - Country:US
Practice Address - Phone:917-523-3113
Practice Address - Fax:718-622-9322
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07166-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist