Provider Demographics
NPI:1689218869
Name:CITRO, CARISSA LYNN (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:LYNN
Last Name:CITRO
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S HOWELL AVE STE M
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4445
Mailing Address - Country:US
Mailing Address - Phone:631-284-2299
Mailing Address - Fax:
Practice Address - Street 1:23 S HOWELL AVE STE M
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4445
Practice Address - Country:US
Practice Address - Phone:631-284-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002898-01237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter