Individual ProviderEmily ProvenzanoSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address1535 Richmond Ave, Staten Island, NY 10314-1520(718) 556-1616PECOS EnrollmentBased on the most recent information from CMS, provider Emily Provenzano does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1104105683Provider TypeIndividualFull NameProvenzano, EmilyGenderFemaleSole ProprietorYesEnumeration Date8/15/2011Last Updated8/28/2012Contact InformationPractice LocationPractice Address1535 Richmond Ave, Staten Island, NY 10314-1520Phone(718) 556-1616FaxUnlisted FaxMailing LocationMailing Address418 Robinson Ave, Staten Island, NY 10312-5142PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense1816016New York