Provider Demographics
NPI:1659524742
Name:FERRARA, MARISA (MA,CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:
Last Name:FERRARA
Suffix:
Gender:F
Credentials:MA,CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 33RD ST
Mailing Address - Street 2:APT 1R
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2146
Mailing Address - Country:US
Mailing Address - Phone:718-721-3090
Mailing Address - Fax:
Practice Address - Street 1:3240 33RD ST
Practice Address - Street 2:APT 1R
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2146
Practice Address - Country:US
Practice Address - Phone:718-721-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012763-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist