Provider Demographics
NPI:1679044317
Name:MARIN, EVELYN GLORIA (MS)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:GLORIA
Last Name:MARIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-2028
Mailing Address - Country:US
Mailing Address - Phone:914-413-9709
Mailing Address - Fax:
Practice Address - Street 1:3120 CORLEAR AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-3976
Practice Address - Country:US
Practice Address - Phone:646-802-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty