Provider Demographics
NPI:1487931366
Name:FARERI, MARIA MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIA MICHELLE
Middle Name:
Last Name:FARERI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:MARIA MICHELLE
Other - Middle Name:
Other - Last Name:D'ANGELO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6335 60TH PL
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2040
Mailing Address - Country:US
Mailing Address - Phone:917-613-0466
Mailing Address - Fax:
Practice Address - Street 1:6335 60TH PL
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2040
Practice Address - Country:US
Practice Address - Phone:917-613-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019610-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist