Provider Demographics
NPI:1598229395
Name:MAFFEI, MARC (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MAFFEI
Suffix:
Gender:M
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 1:68 ROBINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4533
Mailing Address - Country:US
Mailing Address - Phone:917-617-8397
Mailing Address - Fax:
Practice Address - Street 1:115 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-4422
Practice Address - Country:US
Practice Address - Phone:917-617-8397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000000OtherN/A