Provider Demographics
NPI:1710352497
Name:BLORIAN, MARA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:
Last Name:BLORIAN
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 1:15 STATION RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2417
Mailing Address - Country:US
Mailing Address - Phone:516-972-3520
Mailing Address - Fax:
Practice Address - Street 1:15 STATION RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2417
Practice Address - Country:US
Practice Address - Phone:516-972-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024212-1235Z00000X
PASL012236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1OtherUPIN, MEDICARE, MEDICAID