Provider Demographics
NPI:1104062306
Name:GARRETT, MAUREEN O'KELLY (MAUREEN GARRETT)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:O'KELLY
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MAUREEN GARRETT
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:O'KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:3 LINDEN PL
Mailing Address - Street 2:APT 3
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-3681
Mailing Address - Country:US
Mailing Address - Phone:914-366-8010
Mailing Address - Fax:
Practice Address - Street 1:101 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3030
Practice Address - Country:US
Practice Address - Phone:845-627-9816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014422-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist