Provider Demographics
NPI:1417213570
Name:MCCABE, LISAROSE MAHANEY (SLPD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:LISAROSE
Middle Name:MAHANEY
Last Name:MCCABE
Suffix:
Gender:F
Credentials:SLPD, CCC-SLP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ROSE
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:180 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1823
Mailing Address - Country:US
Mailing Address - Phone:201-519-9283
Mailing Address - Fax:
Practice Address - Street 1:180 TERRACE AVE
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1823
Practice Address - Country:US
Practice Address - Phone:201-519-9283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16250235Z00000X
NJ41YS00718600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist