Provider Demographics
NPI:1053565150
Name:PUNZI, LUCILLE M (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LUCILLE
Middle Name:M
Last Name:PUNZI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1526
Mailing Address - Country:US
Mailing Address - Phone:516-932-7414
Mailing Address - Fax:516-932-8730
Practice Address - Street 1:5 BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1526
Practice Address - Country:US
Practice Address - Phone:516-932-7414
Practice Address - Fax:516-932-8730
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004850-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist