Provider Demographics
NPI:1407901804
Name:ELBAUM, MARJORIE RUTH (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:RUTH
Last Name:ELBAUM
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2014
Mailing Address - Country:US
Mailing Address - Phone:631-367-8638
Mailing Address - Fax:
Practice Address - Street 1:14 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2014
Practice Address - Country:US
Practice Address - Phone:631-367-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist