Provider Demographics
NPI:1063719201
Name:ROARKE, ELIZABETH IRENE (MS CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:IRENE
Last Name:ROARKE
Suffix:
Gender:F
Credentials:MS CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E PENN ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4332
Mailing Address - Country:US
Mailing Address - Phone:631-275-1853
Mailing Address - Fax:
Practice Address - Street 1:3623 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-5445
Practice Address - Country:US
Practice Address - Phone:718-531-1800
Practice Address - Fax:718-677-4840
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019486-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist