Provider Demographics
NPI:1679846828
Name:AMENTAS, MAURA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:AMENTAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 COLONIAL RD
Mailing Address - Street 2:APT E1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6153
Mailing Address - Country:US
Mailing Address - Phone:917-519-3965
Mailing Address - Fax:
Practice Address - Street 1:9108 COLONIAL RD
Practice Address - Street 2:APT E1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6153
Practice Address - Country:US
Practice Address - Phone:917-519-3965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2021-09-30
Deactivation Date:2020-12-07
Deactivation Code:
Reactivation Date:2021-09-30
Provider Licenses
StateLicense IDTaxonomies
NY58020419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist