Provider Demographics
NPI:1023318573
Name:PUGLIESE, GINA MARIE (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MRS
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:GRASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2079
Mailing Address - Country:US
Mailing Address - Phone:845-778-1312
Mailing Address - Fax:
Practice Address - Street 1:24 ADAMS DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2079
Practice Address - Country:US
Practice Address - Phone:845-778-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010781-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist