Provider Demographics
NPI:1730324567
Name:BOEHM, MARIAN B
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:B
Last Name:BOEHM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1820
Mailing Address - Country:US
Mailing Address - Phone:516-671-4561
Mailing Address - Fax:516-674-6085
Practice Address - Street 1:30 CLINTON ST
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1820
Practice Address - Country:US
Practice Address - Phone:516-671-4561
Practice Address - Fax:516-674-6085
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002704-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist