Provider Demographics
NPI:1871183384
Name:COLLINS, MAURA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:COLLINS
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 1:41 ELTON RD N
Mailing Address - Street 2:
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2203
Mailing Address - Country:US
Mailing Address - Phone:516-428-5603
Mailing Address - Fax:
Practice Address - Street 1:300 CORPORATE BLVD S
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6862
Practice Address - Country:US
Practice Address - Phone:914-294-6233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030424-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist