Provider Demographics
NPI:1548316441
Name:BRABAZON, CAROLINE CATHERINE (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CATHERINE
Last Name:BRABAZON
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-0006
Mailing Address - Country:US
Mailing Address - Phone:631-286-0343
Mailing Address - Fax:
Practice Address - Street 1:95 DURKEE LN
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5818
Practice Address - Country:US
Practice Address - Phone:631-286-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010393235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist