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General NPI Number Information
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NPI Number | 1437436029
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Entity Type | Organization
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Legal Business Name | CMG SPEECH LANGUAGE PATHOLOGY PLLC
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 1565 RICHMOND RD STE A
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2331
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Country | US
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Telephone | 646-267-9609
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Fax | 315-800-5932
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Provider Business Mailing Address
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Address Line | 1565 RICHMOND RD STE A
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City | STATEN ISLAND
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State | NY
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Zip | 10304-2331
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Country | US
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Telephone | 646-267-9609
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Fax | 215-800-5932
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Authorized Official
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Title or Position | OWNER
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Name | MS. CHRISTINA MARIE GOODHEART
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Credential | MA, CCC-SLP
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Telephone | 646-267-9609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 020071-1
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License Number State | NY
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