Provider Demographics
NPI:1457717324
Name:BOMYEA, MAUREEN
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:BOMYEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13680-3161
Mailing Address - Country:US
Mailing Address - Phone:315-276-0172
Mailing Address - Fax:
Practice Address - Street 1:57 W FRONT ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER FALLS
Practice Address - State:NY
Practice Address - Zip Code:13680-3161
Practice Address - Country:US
Practice Address - Phone:315-276-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant