Provider Demographics
NPI:1851655393
Name:DEMARIA, CARLA JILL (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:JILL
Last Name:DEMARIA
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 1:2279 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-5842
Mailing Address - Country:US
Mailing Address - Phone:518-377-1833
Mailing Address - Fax:
Practice Address - Street 1:107 NOTT TER
Practice Address - Street 2:306
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3170
Practice Address - Country:US
Practice Address - Phone:518-386-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY007941-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist