1457856478 NPI number — ANNETTE MARLIESE PATINO-GONZALEZ M.S. CCC-SLP

Table of content: ANNETTE MARLIESE PATINO-GONZALEZ M.S. CCC-SLP (NPI 1457856478)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457856478 NPI number — ANNETTE MARLIESE PATINO-GONZALEZ M.S. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATINO-GONZALEZ
Provider First Name:
ANNETTE
Provider Middle Name:
MARLIESE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457856478
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 412307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-294-4050
Provider Business Mailing Address Fax Number:
631-760-8306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 OLD OYSTER POINT RD STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23602-7177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-223-1466
Provider Business Practice Location Address Fax Number:
757-233-1467
Provider Enumeration Date:
03/30/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202006513 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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