Provider Demographics
NPI:1386921435
Name:GUARINO, LISA COTICCHIO (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:COTICCHIO
Last Name:GUARINO
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 1:45 WANTAGH AVE. SOUTH
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756
Mailing Address - Country:US
Mailing Address - Phone:516-520-2175
Mailing Address - Fax:516-731-3846
Practice Address - Street 1:45 WANTAGH AVE. SOUTH
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756
Practice Address - Country:US
Practice Address - Phone:516-520-2175
Practice Address - Fax:516-731-3846
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008098-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist