Provider Demographics
NPI:1760250674
Name:MARVUCIC, DIANA (MA, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MARVUCIC
Suffix:
Gender:F
Credentials:MA, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 PAUL AVE APT 15G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1009
Mailing Address - Country:US
Mailing Address - Phone:347-429-5983
Mailing Address - Fax:
Practice Address - Street 1:778 FOREST AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-7803
Practice Address - Country:US
Practice Address - Phone:718-401-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03381801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist