MEDICARE: MARIE FAY RICHARDSON MACCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	015010	NY

General Provider Information

NPI Number	:	1649571050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE FAY RICHARDSON MACCC-SLP

Provider Business Mailing Address
First Line	:	6445 218TH ST
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2237
Country	:	US
Telephone Number	:	718-423-8395
Fax Number	:	718-423-8472

Provider Business Practice Location Address
First Line	:	6445 218TH ST
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2237
Country	:	US
Telephone Number	:	718-423-8395
Fax Number	:	718-423-8472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2010
Last Update Date	:	12/05/2016

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Directions to “ MARIE FAY RICHARDSON MACCC-SLP” Practice Location

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