Provider Demographics
NPI:1013674779
Name:KEANE, MARY KATHERINE (MS, CF-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:KEANE
Suffix:
Gender:F
Credentials:MS, CF-SLP, TSSLD
Other - Prefix:
Other - First Name:MARY KATE
Other - Middle Name:
Other - Last Name:KEANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 DIRUBBO DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567
Mailing Address - Country:US
Mailing Address - Phone:914-703-8669
Mailing Address - Fax:
Practice Address - Street 1:121 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5543
Practice Address - Country:US
Practice Address - Phone:914-703-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1516936211OtherTEACHER OF SPEECH AND LANGUAGE DIFFICULTIES, INITIAL CERTIFICATE