Provider Demographics
NPI:1518009711
Name:MARCARIO, JODI L (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:MARCARIO
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-1936
Mailing Address - Country:US
Mailing Address - Phone:631-929-3883
Mailing Address - Fax:
Practice Address - Street 1:22 15TH ST
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1936
Practice Address - Country:US
Practice Address - Phone:631-929-3883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013295-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist