Basic Information
| Provider Information | |||||||||
| NPI: | 1255694006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIBENEDETTO | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MA, CCC-SLP TSHH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14632 WILLETS POINT BLVD | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113573543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162638797 | ||||||||
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| Practice Location | |||||||||
| Address1: | 189 WHEATLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | BROOKVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115452699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166261000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 06/18/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 013035-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.