Provider Demographics
NPI:1528388105
Name:CARCICH, MARIANN
Entity Type:Individual
Prefix:
First Name:MARIANN
Middle Name:
Last Name:CARCICH
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 1:46 GRANTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2340
Mailing Address - Country:US
Mailing Address - Phone:518-439-6962
Mailing Address - Fax:
Practice Address - Street 1:46 GRANTWOOD RD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2340
Practice Address - Country:US
Practice Address - Phone:518-439-6962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002343-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist