Provider Demographics
NPI:1891163820
Name:COMMUNICATION THERAPY CENTER
Entity Type:Organization
Organization Name:COMMUNICATION THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALYAROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:201-670-0707
Mailing Address - Street 1:391 S MAPLE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-1537
Mailing Address - Country:US
Mailing Address - Phone:201-670-0707
Mailing Address - Fax:201-670-7180
Practice Address - Street 1:391 S MAPLE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-1537
Practice Address - Country:US
Practice Address - Phone:201-670-0707
Practice Address - Fax:201-670-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00743000261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech