Mary Dacierno Speech Language Pathologist PC

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

022956 Issued in NY

Legal business name

MARY DACIERNO SPEECH LANGUAGE PATHOLOGIST PC

Practice address

52 Roman Ave
Apt. 4
Staten Island, NY 10314-2721

Phone

(917) 586-2964

NPI assigned

Apr 7, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary Vitale, M.S. CCC SLP

Title

Speech Language Pathologist

Phone

(917) 586-2964

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480636800000",
    "number": "1033538087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 ROMAN AVE",
            "address_2": "APT. 4",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103142721",
            "telephone_number": "917-586-2964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 ROMAN AVE",
            "address_2": "APT. 4",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103142721",
            "telephone_number": "917-586-2964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY DACIERNO SPEECH LANGUAGE PATHOLOGIST PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-07",
        "last_updated": "2016-12-02",
        "status": "A",
        "authorized_official_last_name": "VITALE",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "917-586-2964",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S. CCC SLP"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "022956",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03764472",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Early Intervention Provider Agency in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Early Intervention Provider Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.