Healthcare Provider Details

I. General information

NPI: 1265938823
Provider Name (Legal Business Name): CORINNE VISCOMI, SPEECH-LANGUAGE PATHOLOGIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GOLDENS BRIDGE RD STE 5
KATONAH NY
10536
US

IV. Provider business mailing address

190 GOLDENS BRIDGE RD STE 5
KATONAH NY
10536-2804
US

V. Phone/Fax

Practice location:
  • Phone: 914-893-2223
  • Fax:
Mailing address:
  • Phone: 914-439-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number026487-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number026487-1
License Number StateNY

VIII. Authorized Official

Name: MRS. CORINNE ELISSA VISCOMI
Title or Position: DIRECTOR
Credential: SLP
Phone: 914-439-1241