Provider Demographics
NPI:1538606462
Name:COLARUSSO, BRIDGET MARIE (MSED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARIE
Last Name:COLARUSSO
Suffix:
Gender:F
Credentials:MSED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SUNRISE HWY W
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1868
Mailing Address - Country:US
Mailing Address - Phone:631-422-1570
Mailing Address - Fax:
Practice Address - Street 1:201 SUNRISE HWY W
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1868
Practice Address - Country:US
Practice Address - Phone:631-422-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026436-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist