# CLARA MAZEPA SLP,P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063924058
- **Authorized official:** CLARA MAZEPA MA,CCC-SLP,TSHH (PRESIDENT)
- **Authorized official phone:** (917) 566-5757

## Contact information

- **Practice address:** 236 NATICK ST, STATEN ISLAND, NY 10306-1626
- **Practice address phone:** (917) 566-5757
- **Mailing address:** 236 NATICK ST, STATEN ISLAND, NY 10306
- **Mailing address phone:** (917) 566-5757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 252Y00000X | Early Intervention Provider Agency | 012278 | NY | Yes |

## Other

- **Enumeration date:** 10/30/2017
- **Last updated:** 10/30/2017