Active NPI
Carol Garvin-Lease
- Speech-Language Pathologist
- Buffalo, NY
National Provider Identifier
1104193572
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 005320-1
- Practice address
- 3780 S Park Ave
Buffalo, NY 14219-1805 - Phone
- (716) 926-1750
- NPI assigned
- Nov 29, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 005320-1 | NY | Primary |
Addresses
Primary practice location
3780 S Park Ave
Buffalo, NY 14219-1805
Mailing address
4339 Beetow Drive
Hamburg, NY 14075
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01390945 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005320-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322524800000",
"number": "1104193572",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4339 BEETOW DRIVE",
"city": "HAMBURG",
"state": "NY",
"postal_code": "14075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3780 S PARK AVE",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142191805",
"telephone_number": "716-926-1750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARVIN-LEASE",
"first_name": "CAROL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-29",
"last_updated": "2011-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "005320-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01390945",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.