1326301623 NPI number — LISA BARONE KOVAC M.A.,CCC,SLP

Table of content: LISA BARONE KOVAC M.A.,CCC,SLP (NPI 1326301623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326301623 NPI number — LISA BARONE KOVAC M.A.,CCC,SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOVAC
Provider First Name:
LISA
Provider Middle Name:
BARONE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.,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:
1326301623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 HOYT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUND RIDGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10576-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-764-5485
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 WEST BOSTON POST ROAD
Provider Second Line Business Practice Location Address:
MAMARONECK UNION FREE SCHOOL DISTRICT
Provider Business Practice Location Address City Name:
MAMARONECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-220-3401
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2012

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:  004079-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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