Provider Demographics
NPI:1760763866
Name:VANCA, HARA (MS NYS-SLP)
Entity Type:Individual
Prefix:
First Name:HARA
Middle Name:
Last Name:VANCA
Suffix:
Gender:M
Credentials:MS NYS-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5627
Mailing Address - Country:US
Mailing Address - Phone:914-787-9365
Mailing Address - Fax:
Practice Address - Street 1:1086 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SHRUB OAK
Practice Address - State:NY
Practice Address - Zip Code:10588-1507
Practice Address - Country:US
Practice Address - Phone:914-528-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist