Provider Demographics
NPI:1902190044
Name:NOONAN, MARISA MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:MARIE
Last Name:NOONAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SCHOFIELD ST
Mailing Address - Street 2:3C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10464-1530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 SCHOFIELD STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10464
Practice Address - Country:US
Practice Address - Phone:917-553-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017442-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist