Provider Demographics
NPI:1043738792
Name:MAMMUCARI, BRITTANY LEIGH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEIGH
Last Name:MAMMUCARI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 BRIDLEPATH CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8815
Mailing Address - Country:US
Mailing Address - Phone:609-922-6157
Mailing Address - Fax:
Practice Address - Street 1:200 EXECUTIVE CENTER PKWY STE 106
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3177
Practice Address - Country:US
Practice Address - Phone:540-446-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist