Healthcare Provider Details

I. General information

NPI: 1952219453
Provider Name (Legal Business Name): MIND BODY SPEECH WELLNESS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2174 HEWLETT AVE STE 216
MERRICK NY
11566-3620
US

IV. Provider business mailing address

2174 HEWLETT AVE STE 216
MERRICK NY
11566-3620
US

V. Phone/Fax

Practice location:
  • Phone: 347-259-0763
  • Fax:
Mailing address:
  • Phone: 347-259-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARISA MARCHICA
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 347-259-0763