Doctor Name: | MRS. LARA ELIZABETH PICANO DIMARTINO |
NPI Number: | 1447425939 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | SA 9429 |
Business Practice Address: | 824 Marjories Way St Augustine, FL - 320922427 |
Business Phone Number: | 9043152702 |
Business Fax Number: | |
Mailing Address: | 824 Marjories Way, ST AUGUSTINE |
State: | FL |
Postal Code: | 320922427 |
Phone Number: | 9043152702 |
Fax Number: | |
NPI Enumeration Date: | 04/25/2008 |
NPI Last Update Date: | 04/25/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA 9429 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |