Provider Demographics
NPI:1932519741
Name:MOCK, CIARA
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:MOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12921-0093
Mailing Address - Country:US
Mailing Address - Phone:518-651-5505
Mailing Address - Fax:
Practice Address - Street 1:22 NEW YORK RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12903-3981
Practice Address - Country:US
Practice Address - Phone:518-561-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023707-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist