Provider Demographics
NPI:1326581828
Name:SCREVANE, PATRICIA (MA, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SCREVANE
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 1:27 W 84TH ST APT 3FE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4854
Mailing Address - Country:US
Mailing Address - Phone:646-491-2415
Mailing Address - Fax:718-937-1847
Practice Address - Street 1:2116 44TH RD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5011
Practice Address - Country:US
Practice Address - Phone:718-937-1682
Practice Address - Fax:718-937-1847
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011780-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist