Provider Demographics
NPI:1285979054
Name:ISMACH, CAROLYN (MA CCC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:ISMACH
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BROAD ST
Mailing Address - Street 2:APT. 2305
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2067
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 BROAD ST
Practice Address - Street 2:APT. 2305
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2067
Practice Address - Country:US
Practice Address - Phone:551-427-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004394235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist