Provider Demographics
NPI:1457587859
Name:CARVAJAL, ANA MARITZA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:MARITZA
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1135
Mailing Address - Country:US
Mailing Address - Phone:718-277-7010
Mailing Address - Fax:718-827-4137
Practice Address - Street 1:200 LINWOOD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1135
Practice Address - Country:US
Practice Address - Phone:718-277-7010
Practice Address - Fax:718-827-4137
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-31
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016461-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist