Provider Demographics
NPI:1851782932
Name:CARNIVALE, MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CARNIVALE
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 1:174 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-6032
Mailing Address - Country:US
Mailing Address - Phone:516-510-1609
Mailing Address - Fax:516-705-5563
Practice Address - Street 1:1225 FRANKLIN AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1691
Practice Address - Country:US
Practice Address - Phone:516-512-8905
Practice Address - Fax:516-543-0664
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024463-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist