Provider Demographics
NPI:1083390371
Name:CERVEN, MEGHAN ROSE
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ROSE
Last Name:CERVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 US-6
Mailing Address - Street 2:
Mailing Address - City:MAHPOAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541
Mailing Address - Country:US
Mailing Address - Phone:845-519-2295
Mailing Address - Fax:
Practice Address - Street 1:61 LEO LN
Practice Address - Street 2:
Practice Address - City:POUGHQUAG
Practice Address - State:NY
Practice Address - Zip Code:12570-5411
Practice Address - Country:US
Practice Address - Phone:845-227-7205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist