Provider Demographics
NPI:1487269858
Name:CUZZACREA, CARLEY (AUD CCC-A)
Entity type:Individual
Prefix:DR
First Name:CARLEY
Middle Name:
Last Name:CUZZACREA
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 1ST ST APT 202
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-3403
Mailing Address - Country:US
Mailing Address - Phone:716-930-8375
Mailing Address - Fax:
Practice Address - Street 1:1401 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5012
Practice Address - Country:US
Practice Address - Phone:575-446-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-13
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAUD7194231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist