MEDICARE: ALLISON SOUTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YS0200X	School Counselor
2	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1649642893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON SOUTO

Provider Business Mailing Address
First Line	:	2536 WANTAGH AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-4440
Country	:	US
Telephone Number	:	516-220-8554
Fax Number	:

Provider Business Practice Location Address
First Line	:	2536 WANTAGH AVE
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-4440
Country	:	US
Telephone Number	:	516-220-8554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	10/28/2015

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Directions to “ ALLISON SOUTO ” Practice Location

Language	Start Address	Practice Location

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