Provider Demographics
NPI:1124351762
Name:PASTORE, CATERINA ANNE (MACCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CATERINA
Middle Name:ANNE
Last Name:PASTORE
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9606
Mailing Address - Country:US
Mailing Address - Phone:315-635-2936
Mailing Address - Fax:
Practice Address - Street 1:2515 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9606
Practice Address - Country:US
Practice Address - Phone:315-635-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005724-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005724-1OtherSPEECH-LANGUAGE PATHOLOGIST