Provider Demographics
NPI:1093960189
Name:MOONEY, MARILYN S
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:S
Last Name:MOONEY
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 1:509 GIFFORDS CHURCH RD.
Mailing Address - Street 2:
Mailing Address - City:SCNENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306
Mailing Address - Country:US
Mailing Address - Phone:518-355-0826
Mailing Address - Fax:518-356-4725
Practice Address - Street 1:509 GIFFORDS CHURCH RD.
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306
Practice Address - Country:US
Practice Address - Phone:518-355-0826
Practice Address - Fax:518-356-4725
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004935-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist