Provider Demographics
NPI:1104326404
Name:LEVY, CYNTHIA (MACCC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:LEVY
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 ASCOT RD
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2160
Mailing Address - Country:US
Mailing Address - Phone:908-889-0626
Mailing Address - Fax:
Practice Address - Street 1:891 ASCOT RD
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-2160
Practice Address - Country:US
Practice Address - Phone:908-889-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00077000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist