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General NPI Number Information
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NPI Number | 1861646044
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Entity Type | Individual
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Provider Name | MARY J PRIME-NELSON MS, CCC/SLP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 300 PELHAM RD #7H
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City | NEW ROCHELLE
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State | NY
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Zip | 10805-2238
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Country | US
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Telephone | 352-300-0706
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Fax | 914-355-5320
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Provider Business Mailing Address
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Address Line | 300 PELHAM RD #7H
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City | NEW ROCHELLE
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State | NY
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Zip | 10805-2238
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Country | US
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Telephone | 352-300-0706
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Fax | 914-355-5320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 007573-1
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License Number State | NY
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