MEDICARE: MS. LISA PAOLOTTI M.A., C.C.C.-S.L.P.

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	006126	NY

General Provider Information

NPI Number	:	1225427750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA PAOLOTTI M.A., C.C.C.-S.L.P.

Provider Business Mailing Address
First Line	:	68B MACKEY AVE
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-3934
Country	:	US
Telephone Number	:	516-395-9391
Fax Number	:

Provider Business Practice Location Address
First Line	:	68B MACKEY AVE
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-3934
Country	:	US
Telephone Number	:	516-395-9391
Fax Number	:

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

Provider Enumeration Date	:	01/21/2015
Last Update Date	:	01/21/2015

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