Provider Demographics
NPI:1417002643
Name:PECORARO, GEORGINA LOLLY (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:LOLLY
Last Name:PECORARO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:82 OAKLAND MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8600
Mailing Address - Country:US
Mailing Address - Phone:646-236-9099
Mailing Address - Fax:
Practice Address - Street 1:120 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2946
Practice Address - Country:US
Practice Address - Phone:718-815-0768
Practice Address - Fax:718-815-4098
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013450-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist