Provider Demographics
NPI:1598920787
Name:WARREN, MARCIA (MA,CCC-A)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 WHITE PLAINS RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5113
Mailing Address - Country:US
Mailing Address - Phone:914-984-2534
Mailing Address - Fax:
Practice Address - Street 1:3663 ROUTE 9 N STE 102
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3518
Practice Address - Country:US
Practice Address - Phone:732-679-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-00874231H00000X
NJ41YA00087600231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4246971OtherMEDICARE PTAN
OHP00681450OtherMEDICARE RAILROAD PTAN
OH0972309Medicaid
OH20855147Medicaid
4246971OtherMEDICARE PTAN
OHE9250483Medicare PIN