Provider Demographics
NPI:1366755720
Name:KRINITZ, MARLA STACEY (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:STACEY
Last Name:KRINITZ
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 BROADWAY
Mailing Address - Street 2:APT 523
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3214
Mailing Address - Country:US
Mailing Address - Phone:917-861-9210
Mailing Address - Fax:
Practice Address - Street 1:2350 BROADWAY
Practice Address - Street 2:APT 523
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3214
Practice Address - Country:US
Practice Address - Phone:917-861-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008819-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist