National Provider Identifier
Mary Provenzano
Mary Provenzano is listed in the NPPES registry with a primary specialty of Speech-Language Pathologist in Webster, NY and a listed phone number of (585) 216-0000.
Profile Overview
- NPI
- 1285911701
- Provider Type
- Individual
- Primary Specialty
- Speech-Language Pathologist
- Enumeration Date
- November 11, 2011
- Last Updated
- November 11, 2011
Practice Location
- 119 South Ave
- Webster, NY 14580-3559
Phone: (585) 216-0000
Mailing Address
- 1867 State RD
- Webster, NY 14580-9303
Specialties
- Speech-Language Pathologist (235Z00000X)
Full Record
- NPI
- 1285911701
- Entity Type
- Individual
- Last Name
- Provenzano
- First Name
- Mary
- Name Prefix
- Mrs.
- Provider Other Last Name
- Harissis-Provenzano
- Provider Other First Name
- Mary
- Provider Other Name Prefix Text
- Mrs.
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 1867 State RD
- Mailing City
- Webster
- Mailing State
- NY
- Mailing ZIP Code
- 14580-9303
- Mailing Country
- US
- Mailing Phone
- (585) 872-4561
- Practice Street Address
- 119 South Ave
- Practice City
- Webster
- Practice State
- NY
- Practice ZIP Code
- 14580-3559
- Practice Country
- US
- Practice Phone
- (585) 216-0000
- Enumeration Date
- November 11, 2011
- Last Updated
- November 11, 2011
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Speech-Language Pathologist (235Z00000X)