Provider Demographics
NPI:1972701605
Name:MOONE, MARIANNE D (MA CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:D
Last Name:MOONE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4982
Mailing Address - Country:US
Mailing Address - Phone:516-826-1862
Mailing Address - Fax:516-826-4449
Practice Address - Street 1:187 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4982
Practice Address - Country:US
Practice Address - Phone:516-826-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY703235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist