Provider Demographics
NPI:1497837082
Name:MORMANDO, BETH F (MA CCCSLP)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:F
Last Name:MORMANDO
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SARATOGA BRIDGES BLVD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020
Mailing Address - Country:US
Mailing Address - Phone:518-587-5747
Mailing Address - Fax:518-583-9607
Practice Address - Street 1:16 SARATOGA BRIDGES BLVD
Practice Address - Street 2:SARATOGA BRIDGES
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-587-0723
Practice Address - Fax:518-583-9607
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0157611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist