Provider Demographics
NPI:1720732043
Name:MORA, ROSALBA MIYAREY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ROSALBA
Middle Name:MIYAREY
Last Name:MORA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1959
Mailing Address - Country:US
Mailing Address - Phone:347-257-2925
Mailing Address - Fax:
Practice Address - Street 1:1 RANGER RD
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3948
Practice Address - Country:US
Practice Address - Phone:978-722-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-06
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist