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General NPI Number Information
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NPI Number | 1821515073
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Entity Type | Organization
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Legal Business Name | SPEECH PATHOLOGY EVALUATION FOR ADULTS AND KIDS, P.C.
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 08/28/2017
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Provider Practice Location Address
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Address Line | 55 POST AVE
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City | WESTBURY
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State | NY
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Zip | 11590-4361
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Country | US
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Telephone | 516-510-1609
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 106
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11571-0106
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Country | US
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Telephone | 516-510-1609
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIE A CARNIVALE
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Credential | MA, CCC-SLP
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Telephone | 516-510-1609
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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 | 024463
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License Number State | NY
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