Provider Demographics
NPI:1467907469
Name:VANBEEKOM, MARAH
Entity Type:Individual
Prefix:
First Name:MARAH
Middle Name:
Last Name:VANBEEKOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 DITMAS AVE
Mailing Address - Street 2:APT 5G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6964
Mailing Address - Country:US
Mailing Address - Phone:917-455-7658
Mailing Address - Fax:
Practice Address - Street 1:2116 DITMAS AVE
Practice Address - Street 2:APT 5G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6964
Practice Address - Country:US
Practice Address - Phone:917-455-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist