Provider Demographics
NPI:1952439366
Name:O'LEARY, MAURA B (CCC-SLP, TSHH)
Entity Type:Individual
Prefix:MS
First Name:MAURA
Middle Name:B
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:CCC-SLP, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 OLD NECK RD
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2811
Mailing Address - Country:US
Mailing Address - Phone:516-987-3380
Mailing Address - Fax:
Practice Address - Street 1:49 OLD NECK RD
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934
Practice Address - Country:US
Practice Address - Phone:516-987-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016127-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist