Basic Information
| Provider Information | |||||||||
| NPI: | 1316154099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELELLA | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANGELA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 SAW MILL RIVER ROAD-2ND FLOOR | ||||||||
| Address2: | |||||||||
| City: | HAWTHORNE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105321533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886330033 | ||||||||
| FaxNumber: | 9145931802 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 PLAZA W | ||||||||
| Address2: | VOSBURGH PAVILION | ||||||||
| City: | VALHALLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105951572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9145944912 | ||||||||
| FaxNumber: | 9145944853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 09226-1 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.