Provider Demographics
NPI:1487421343
Name:ANTONECCHIA, OLIVIA MARIE (MA, CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARIE
Last Name:ANTONECCHIA
Suffix:
Gender:F
Credentials:MA, CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6715
Mailing Address - Country:US
Mailing Address - Phone:914-882-8737
Mailing Address - Fax:
Practice Address - Street 1:468 E 140TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2752
Practice Address - Country:US
Practice Address - Phone:914-882-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033881-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist