Provider Demographics
NPI:1871746248
Name:SUMMERVILLE-SABITUS, MARY THERESA (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESA
Last Name:SUMMERVILLE-SABITUS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SPRINGTREE BLVD
Mailing Address - Street 2:
Mailing Address - City:APALACHIN
Mailing Address - State:NY
Mailing Address - Zip Code:13732-3816
Mailing Address - Country:US
Mailing Address - Phone:607-725-5967
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGTREE BLVD
Practice Address - Street 2:
Practice Address - City:APALACHIN
Practice Address - State:NY
Practice Address - Zip Code:13732-3816
Practice Address - Country:US
Practice Address - Phone:607-725-5967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006909-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist