Mary Provenzano

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

008559 Issued in NY

Practice address

119 South Ave
Webster, NY 14580-3559

Phone

(585) 216-0000

NPI assigned

Nov 11, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Mary Harissis-Provenzano Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Webster Central School District

  • Local Education Agency (LEA)
  • Webster, NY
  • NPI 1598800138
  NPD (past)

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

{
    "created_epoch": "1320969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320969600000",
    "number": "1285911701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1867 STATE RD",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145809303",
            "telephone_number": "585-872-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 SOUTH AVE",
            "city": "WEBSTER",
            "state": "NY",
            "postal_code": "145803559",
            "telephone_number": "585-216-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENZANO",
        "first_name": "MARY",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-11",
        "last_updated": "2011-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NY",
            "license": "008559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "HARISSIS-PROVENZANO",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alyssa Postilio, DPT
• Leslie Carol Pow, RN
• Renee Prince, RN
• Procare Physical Therapy, LLC
• Julie Ann Provenzano
• Kellie Provo
• Elizabeth Marie Przybylowicz
• Laura Puccia, OD
• David Puchala
• Scott J Pugliese, PT

• Speech-Language Pathologist in Webster, NY
• Providers in Webster, NY by specialty
• Speech-Language Pathologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 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.

Verify at the official NPI Registry.