Individual
MRS. CAROLINE KAY VIVACQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2550 88TH ST, EAST ELMHURST, NY 11369-1010
(718) 397-7851
Mailing address
16 TARRY LN, LEVITTOWN, NY 11756-4026
(646) 284-2602
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
025013
NY
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04307851
—
NY
Enumeration date
05/07/2014
Last updated
11/13/2019
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