Provider Demographics
NPI:1063843365
Name:MAZIER, MARTHA T (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:T
Last Name:MAZIER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:T
Other - Last Name:MONTALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:193 24TH STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232
Mailing Address - Country:US
Mailing Address - Phone:646-334-1551
Mailing Address - Fax:
Practice Address - Street 1:193 24TH STREET
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232
Practice Address - Country:US
Practice Address - Phone:646-334-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025322235Z00000X
NY025322-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04311235Medicaid