Provider Demographics
NPI:1437649894
Name:LUCIA-PRESTA, MARIA GRACE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:GRACE
Last Name:LUCIA-PRESTA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:GRACE
Other - Last Name:LUCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:165 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-5403
Mailing Address - Country:US
Mailing Address - Phone:914-419-5148
Mailing Address - Fax:
Practice Address - Street 1:963 SCARSDALE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4852
Practice Address - Country:US
Practice Address - Phone:914-810-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02860-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05980947Medicaid