Provider Demographics
NPI:1366697773
Name:DULFON, LIANNA FELIZ (MA-CCC/SLP TSSLD)
Entity type:Individual
Prefix:MRS
First Name:LIANNA
Middle Name:FELIZ
Last Name:DULFON
Suffix:
Gender:F
Credentials:MA-CCC/SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940
Mailing Address - Country:US
Mailing Address - Phone:631-804-3337
Mailing Address - Fax:
Practice Address - Street 1:43 SEABREEZE AVE
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1111
Practice Address - Country:US
Practice Address - Phone:631-804-3337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017754-1235Z00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03637056Medicaid