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Individual

MRS. VIVIAN O. PENCEAL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
TSHH, MSED

Contact information

Practice address
25519 149TH AVE, 2ND FLOOR, ROSEDALE, NY 11422-2812
(917) 922-3668
Mailing address
25519 149TH AVE, 2ND FLOOR, ROSEDALE, NY 11422-2812
(917) 922-3668

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
215490
NY
235500000X
Speech/Language/Hearing Specialist/Technologist
Primary
215490
NY

Other

Enumeration date
05/04/2012
Last updated
06/08/2012
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