Provider Demographics
NPI:1528265204
Name:DI CARLO, MARIA LAURA (CCC-MS-SLP-AUD)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LAURA
Last Name:DI CARLO
Suffix:
Gender:F
Credentials:CCC-MS-SLP-AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 SW 92ND TER
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-4219
Mailing Address - Country:US
Mailing Address - Phone:305-439-3488
Mailing Address - Fax:305-763-8029
Practice Address - Street 1:900 BAY DR APT 919
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-5672
Practice Address - Country:US
Practice Address - Phone:305-397-8993
Practice Address - Fax:305-763-8029
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY6289231H00000X
FLSA8993235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY2689OtherSTATE LICENSE
NY017068OtherSTATE LICENSE
FLSA8993OtherSTATE LICENSE