Provider Demographics
NPI:1265789176
Name:PERALTA, MARIANA NOEMI (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIANA
Middle Name:NOEMI
Last Name:PERALTA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1276 CROES AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2834
Mailing Address - Country:US
Mailing Address - Phone:917-349-3332
Mailing Address - Fax:
Practice Address - Street 1:3036 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5733
Practice Address - Country:US
Practice Address - Phone:718-823-3190
Practice Address - Fax:718-829-6667
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0227291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist