Provider Demographics
NPI:1982809034
Name:PASSADAKES, MARIA (MA CCCSLP)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:
Last Name:PASSADAKES
Suffix:
Gender:F
Credentials:MA CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GREENFIELDS LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971
Mailing Address - Country:US
Mailing Address - Phone:631-765-5563
Mailing Address - Fax:
Practice Address - Street 1:556 EAST MAIN STREET
Practice Address - Street 2:JUST KIDS EARLY CHILDHOOD LEARNING CENTER
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901
Practice Address - Country:US
Practice Address - Phone:631-369-1927
Practice Address - Fax:631-369-1957
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist