Provider Demographics
NPI:1558615229
Name:LAVY, MAUREEN ANN
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANN
Last Name:LAVY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:LAVY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SPEECH PATHOLOGIST
Mailing Address - Street 1:3639 WILDFLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9610
Mailing Address - Country:US
Mailing Address - Phone:315-469-3050
Mailing Address - Fax:
Practice Address - Street 1:159 W 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2045
Practice Address - Country:US
Practice Address - Phone:315-342-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028513235Z00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist