Organization
MARY DACIERNO SPEECH LANGUAGE PATHOLOGIST PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY VITALE M.S. CCC SLP (SPEECH LANGUAGE PATHOLOGIST)
(917) 586-2964
Entity
Organization
Contact information
Practice address
52 ROMAN AVE, APT. 4, STATEN ISLAND, NY 10314-2721
(917) 586-2964
Mailing address
52 ROMAN AVE, APT. 4, STATEN ISLAND, NY 10314-2721
(917) 586-2964
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
022956
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03764472
—
NY
Enumeration date
04/07/2014
Last updated
12/02/2016
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