1912613290 NPI number — MARYROSE SENO SPEECH THERAPIST

Table of content: MARYROSE SENO SPEECH THERAPIST (NPI 1912613290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912613290 NPI number — MARYROSE SENO SPEECH THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SENO
Provider First Name:
MARYROSE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SPEECH THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SENO
Provider Other First Name:
MARYROSE
Provider Other Middle Name:
CABATO
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SPEECH THERAPIST
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912613290
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7289 CALAMUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11377-7635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-476-1372
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3252 37TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11103-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-316-6005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  034013-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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