Provider Demographics
NPI:1932416153
Name:SEVERINO, DORINE YVONNE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DORINE
Middle Name:YVONNE
Last Name:SEVERINO
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 1:2724 HALL ST
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-3228
Mailing Address - Country:US
Mailing Address - Phone:607-748-4502
Mailing Address - Fax:
Practice Address - Street 1:2724 HALL ST
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-3228
Practice Address - Country:US
Practice Address - Phone:607-748-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011975-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12055553OtherASHA
NY6606407OtherSTATE LICENSE