Provider Demographics
NPI:1629223516
Name:SOMAN, MARIAELENA (MA, CCC-SLP, LBA)
Entity type:Individual
Prefix:
First Name:MARIAELENA
Middle Name:
Last Name:SOMAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1316
Mailing Address - Country:US
Mailing Address - Phone:917-709-3473
Mailing Address - Fax:
Practice Address - Street 1:319 N IDAHO AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1316
Practice Address - Country:US
Practice Address - Phone:917-709-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-11-9401103K00000X
NY016810235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst