Provider Demographics
NPI:1770887507
Name:MARCHESANI, MARY TERESA
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TERESA
Last Name:MARCHESANI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:TERESA
Other - Last Name:WINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1575 HERZEL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-4234
Mailing Address - Country:US
Mailing Address - Phone:631-422-1223
Mailing Address - Fax:
Practice Address - Street 1:1575 HERZEL BLVD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-4234
Practice Address - Country:US
Practice Address - Phone:631-422-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist