Provider Demographics
NPI:1598898181
Name:MANEVICH, MARIA (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MANEVICH
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 SHORE FRONT PKWY
Mailing Address - Street 2:#1-O
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-2127
Mailing Address - Country:US
Mailing Address - Phone:718-945-6988
Mailing Address - Fax:
Practice Address - Street 1:8100 SHORE FRONT PKWY
Practice Address - Street 2:#1-O
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-2127
Practice Address - Country:US
Practice Address - Phone:718-945-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002024-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist