Healthcare Provider Details

I. General information

NPI: 1417874876
Provider Name (Legal Business Name): LISA PICCIOTTO SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA GRASSI SLP-CCC

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ALCALA DR
BRICK NJ
08723-7601
US

IV. Provider business mailing address

23 ALCALA DR
BRICK NJ
08723-7601
US

V. Phone/Fax

Practice location:
  • Phone: 845-926-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00774000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: