Provider Demographics
NPI:1811142573
Name:MASSARI, MARYANN ELIZABETH (MA, CCC-SLP/TSHH)
Entity type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:ELIZABETH
Last Name:MASSARI
Suffix:
Gender:F
Credentials:MA, CCC-SLP/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:16 POST ST
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1809
Mailing Address - Country:US
Mailing Address - Phone:347-539-6427
Mailing Address - Fax:718-899-9061
Practice Address - Street 1:16 POST ST
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1809
Practice Address - Country:US
Practice Address - Phone:347-539-6427
Practice Address - Fax:718-899-9061
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-22
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 174H00000X
NY024638-01225700000X
NY013002-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist