Provider Demographics
NPI:1538443379
Name:WESTBROOK, MARY (MA,CCC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 NEWKIRK RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3518
Mailing Address - Country:US
Mailing Address - Phone:914-793-0614
Mailing Address - Fax:
Practice Address - Street 1:700 ASHFORD AVE
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2406
Practice Address - Country:US
Practice Address - Phone:914-697-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001423-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist