Provider Demographics
NPI:1881902088
Name:FREASO, TERESA A (MS/CCC/LSP)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:A
Last Name:FREASO
Suffix:
Gender:F
Credentials:MS/CCC/LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ALLYSON PL
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2000
Mailing Address - Country:US
Mailing Address - Phone:631-689-5480
Mailing Address - Fax:
Practice Address - Street 1:6 ALLYSON PL
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2000
Practice Address - Country:US
Practice Address - Phone:631-689-5480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003522-1235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0624Medicaid