Provider Demographics
NPI:1194960146
Name:SELTZBERG, MAUREEN (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:SELTZBERG
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:SELTZBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:2500 WALLINGTON WAY
Mailing Address - Street 2:STE 103
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1505
Mailing Address - Country:US
Mailing Address - Phone:410-442-9791
Mailing Address - Fax:
Practice Address - Street 1:215 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2112
Practice Address - Country:US
Practice Address - Phone:917-922-2845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-04
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008019-1235Z00000X
MD06499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist