Provider Demographics
NPI:1649571050
Name:RICHARDSON, MARIE FAY (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIE FAY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:MARIE FAY
Other - Middle Name:
Other - Last Name:ARBETINOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MACCC-SLP
Mailing Address - Street 1:6445 218TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2237
Mailing Address - Country:US
Mailing Address - Phone:718-423-8395
Mailing Address - Fax:718-423-8472
Practice Address - Street 1:6445 218TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2237
Practice Address - Country:US
Practice Address - Phone:718-423-8395
Practice Address - Fax:718-423-8472
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist