Provider Demographics
NPI:1588088413
Name:BERTOLDI, BETH ALYSE (MS CCC-SLP TSSLD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ALYSE
Last Name:BERTOLDI
Suffix:
Gender:F
Credentials:MS 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 1:435 E 79TH ST
Mailing Address - Street 2:#10B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 E 79TH ST
Practice Address - Street 2:#10B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1034
Practice Address - Country:US
Practice Address - Phone:212-517-5743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022922-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist