Healthcare Provider Details

I. General information

NPI: 1386951804
Provider Name (Legal Business Name): MARY-MARGARET EPIFANO M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD PAVILION 800, SUITE 209
VOORHEES NJ
08043-4501
US

IV. Provider business mailing address

2301 E EVESHAM RD PAVILION 800, SUITE 209
VOORHEES NJ
08043-4501
US

V. Phone/Fax

Practice location:
  • Phone: 856-651-0060
  • Fax: 856-651-0061
Mailing address:
  • Phone: 856-651-0060
  • Fax: 856-651-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00657300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: