Provider Demographics
NPI:1922178698
Name:MAZZACCARO, MARY MARGARET M (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY MARGARET
Middle Name:M
Last Name:MAZZACCARO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1514
Mailing Address - Country:US
Mailing Address - Phone:570-348-6299
Mailing Address - Fax:570-961-4708
Practice Address - Street 1:2300 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1514
Practice Address - Country:US
Practice Address - Phone:570-348-6299
Practice Address - Fax:570-961-4708
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004204L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist