Provider Demographics
NPI:1467691782
Name:VIVIAN LIFF SPEECH THERAPY, PC
Entity Type:Organization
Organization Name:VIVIAN LIFF SPEECH THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:SPEECH LANGUAGE PATH
Authorized Official - Phone:845-583-4283
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:KAUNEONGA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12749-0600
Mailing Address - Country:US
Mailing Address - Phone:845-583-4283
Mailing Address - Fax:845-583-5476
Practice Address - Street 1:90 HORSEHOE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:KAUNEGONA LAKE
Practice Address - State:NY
Practice Address - Zip Code:12749
Practice Address - Country:US
Practice Address - Phone:845-583-4283
Practice Address - Fax:845-583-5476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0087791252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency