Provider Demographics
NPI:1619222676
Name:GARVEY, MARY JUDITH (MSED)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JUDITH
Last Name:GARVEY
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1041
Mailing Address - Country:US
Mailing Address - Phone:914-954-6105
Mailing Address - Fax:
Practice Address - Street 1:32 WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-1041
Practice Address - Country:US
Practice Address - Phone:914-954-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY46081252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency