Provider Demographics
NPI:1841523453
Name:MASSONE, MAGDALENA MERCEDES (SLP)
Entity type:Individual
Prefix:MISS
First Name:MAGDALENA
Middle Name:MERCEDES
Last Name:MASSONE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MAGDALENA
Other - Middle Name:MERCEDES
Other - Last Name:MASSONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, SLP
Mailing Address - Street 1:9922 67TH RD APT 4D
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3083
Mailing Address - Country:US
Mailing Address - Phone:631-697-9102
Mailing Address - Fax:
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019527-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist