Provider Demographics
NPI:1447404066
Name:FANTAUZZI, CARMEN ELENA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:ELENA
Last Name:FANTAUZZI
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 75TH PL
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1219
Mailing Address - Country:US
Mailing Address - Phone:646-234-3744
Mailing Address - Fax:
Practice Address - Street 1:6107 75TH PL
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1219
Practice Address - Country:US
Practice Address - Phone:646-234-3744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018482-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist