Healthcare Provider Details

I. General information

NPI: 1972241123
Provider Name (Legal Business Name): MICHAELA ROCHELLE BARATTA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E CHESTNUT ST STE 104
ROME NY
13440-2834
US

IV. Provider business mailing address

1500 N JAMES ST
ROME NY
13440-2844
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-7952
  • Fax: 315-337-0991
Mailing address:
  • Phone: 315-337-7952
  • Fax: 315-337-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number031573
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: