Individual ProviderMary FourteSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersPractice Address1535 Richmond Ave, Staten Island, NY 10314-1520(718) 556-1616PECOS EnrollmentBased on the most recent information from CMS, provider Mary Fourte does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1770711897Provider TypeIndividualFull NameFourte, MaryCredentialMS CCC-SLPGenderFemaleSole ProprietorYesEnumeration Date6/26/2009Last Updated6/26/2009Contact InformationPractice LocationPractice Address1535 Richmond Ave, Staten Island, NY 10314-1520Phone(718) 556-1616FaxUnlisted FaxMailing LocationMailing Address331 Orange Rd, Montclair, NJ 07042-4311PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode235Z00000XPrimaryDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicense013797-1New YorkCode235Z00000XDescriptionSpeech-Language PathologistSpeech, Language and Hearing Service ProvidersLicenseYS00431600New Jersey