Provider Demographics
NPI:1932269727
Name:MAFFEI, LINDA SHORE (MSCCCSLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SHORE
Last Name:MAFFEI
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 STATE ROUTE 94
Mailing Address - Street 2:
Mailing Address - City:BLAIRSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07825-2116
Mailing Address - Country:US
Mailing Address - Phone:908-362-7247
Mailing Address - Fax:908-362-7272
Practice Address - Street 1:169 STATE ROUTE 94
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07825-2116
Practice Address - Country:US
Practice Address - Phone:908-362-7247
Practice Address - Fax:908-362-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00110100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8116560 001OtherCIGNA
NJ864969OtherAETNA