MEDICARE: MS. MARISSA CATHERINE TINOCO M.A. CCC SLP TSS

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	023063-1	NY

General Provider Information

NPI Number	:	1316294002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISSA CATHERINE TINOCO M.A. CCC SLP TSS

Provider Business Mailing Address
First Line	:	42 BARKER AVE APT 3D
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-1620
Country	:	US
Telephone Number	:	631-645-5528
Fax Number	:

Provider Business Practice Location Address
First Line	:	254 S MAIN ST STE 400
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-3363
Country	:	US
Telephone Number	:	845-638-1592
Fax Number	:

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

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	11/28/2016

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