Provider Demographics
NPI:1871993329
Name:LIVINGSTON, ELAINE (MA,CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:PULEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,CCC-SLP
Mailing Address - Street 1:37 DEBERG DR
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7249
Mailing Address - Country:US
Mailing Address - Phone:201-658-8664
Mailing Address - Fax:
Practice Address - Street 1:611 PARK AVE
Practice Address - Street 2:APT. 303
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4572
Practice Address - Country:US
Practice Address - Phone:201-658-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07448235Z00000X
MD14025104235Z00000X
NJ41YS00691700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist