Provider Demographics
NPI:1104136068
Name:FREITAS, MARYBETH CHRISTINA (MS/CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:CHRISTINA
Last Name:FREITAS
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 MOSEY LANE
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219
Mailing Address - Country:US
Mailing Address - Phone:716-672-9273
Mailing Address - Fax:716-648-0942
Practice Address - Street 1:30 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:DELEVAN
Practice Address - State:NY
Practice Address - Zip Code:14042
Practice Address - Country:US
Practice Address - Phone:716-492-9450
Practice Address - Fax:716-492-9452
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009884-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist