Healthcare Provider Details

I. General information

NPI: 1811142573
Provider Name (Legal Business Name): MARYANN ELIZABETH MASSARI MA, CCC-SLP/TSHH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2008
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 POST ST
GLEN HEAD NY
11545-1809
US

IV. Provider business mailing address

16 POST ST
GLEN HEAD NY
11545-1809
US

V. Phone/Fax

Practice location:
  • Phone: 347-539-6427
  • Fax: 718-899-9061
Mailing address:
  • Phone: 347-539-6427
  • Fax: 718-899-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number024638-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number013002-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: