Provider Demographics
NPI:1437463197
Name:LAJARA, GLADYS (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:LAJARA
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 MULFORD AVE
Mailing Address - Street 2:APT. #6-M
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4318
Mailing Address - Country:US
Mailing Address - Phone:718-414-7239
Mailing Address - Fax:
Practice Address - Street 1:3942A E. TREMONT AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465
Practice Address - Country:US
Practice Address - Phone:347-398-8358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015066-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist