Provider Demographics
NPI:1447543962
Name:CARRUBBA, ROBERTA (MS,, CCC)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:
Last Name:CARRUBBA
Suffix:
Gender:F
Credentials:MS,, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 CRONSTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1232
Mailing Address - Country:US
Mailing Address - Phone:718-945-9658
Mailing Address - Fax:
Practice Address - Street 1:13810 CRONSTON AVE
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1232
Practice Address - Country:US
Practice Address - Phone:718-945-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003907-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist