Provider Demographics
NPI:1750784518
Name:MCAULIFFE, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCAULIFFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BRENNAN-MCAULIFFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 LITTLEWORTH LN
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1907
Mailing Address - Country:US
Mailing Address - Phone:917-498-9814
Mailing Address - Fax:
Practice Address - Street 1:200 LITTLEWORTH LN
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1907
Practice Address - Country:US
Practice Address - Phone:917-498-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist