Provider Demographics
NPI:1962388470
Name:CAVISSIMO, JANINE MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:MARIE
Last Name:CAVISSIMO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:JANINE
Other - Middle Name:MARIE
Other - Last Name:MCGOVERN-LAWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:159 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1627
Mailing Address - Country:US
Mailing Address - Phone:201-709-4444
Mailing Address - Fax:973-235-1304
Practice Address - Street 1:159 HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1627
Practice Address - Country:US
Practice Address - Phone:201-709-4444
Practice Address - Fax:973-235-1304
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00166400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist