MEDICARE: MAXINE CARRASCO-CABA

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	29957	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	235Z00000X	Speech-Language Pathologist	6143	CT

General Provider Information

NPI Number	:	1932673316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXINE CARRASCO-CABA

Provider Business Mailing Address
First Line	:	4475 HENRY HUDSON PKWY APT 5H
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10471-3865
Country	:	US
Telephone Number	:	917-259-9407
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 KENNEDY AVE UNIT 1113
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5772
Country	:	US
Telephone Number	:	917-259-9407
Fax Number	:

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

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	06/10/2022

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Directions to “ MAXINE CARRASCO-CABA ” Practice Location

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