MEDICARE: MARISA MCAVOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist	031362	NY

General Provider Information

NPI Number	:	1376152926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA MCAVOY

Provider Business Mailing Address
First Line	:	3301 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4241
Country	:	US
Telephone Number	:	718-998-4298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2020
Last Update Date	:	12/13/2021

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Directions to “ MARISA MCAVOY ” Practice Location

Language	Start Address	Practice Location

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