MEDICARE: MS. BARBARA ANNE DECICCO SLP-CCC

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	235Z00000X	Speech-Language Pathologist	003228-1	NY

General Provider Information

NPI Number	:	1093793044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA ANNE DECICCO SLP-CCC

Provider Business Mailing Address
First Line	:	83 MAIDEN LN
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10038-4812
Country	:	US
Telephone Number	:	212-780-2378
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 MAIDEN LN
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10038-4812
Country	:	US
Telephone Number	:	212-780-2378
Fax Number	:

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	12/19/2012

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