Provider Demographics
NPI:1386870384
Name:ESPINOSA, CAROL MARISOL (MS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARISOL
Last Name:ESPINOSA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25611 PEMBROKE AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1035
Mailing Address - Country:US
Mailing Address - Phone:917-273-3272
Mailing Address - Fax:
Practice Address - Street 1:25611 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020-1035
Practice Address - Country:US
Practice Address - Phone:917-273-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015762-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist