Provider Demographics
NPI:1164730859
Name:SAMUELS, ELLEN M (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENRIDGE AVE
Mailing Address - Street 2:UNIT 2-D
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1237
Mailing Address - Country:US
Mailing Address - Phone:914-946-1177
Mailing Address - Fax:914-946-1177
Practice Address - Street 1:30 GREENRIDGE AVE
Practice Address - Street 2:UNIT 2-D
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1237
Practice Address - Country:US
Practice Address - Phone:914-946-1177
Practice Address - Fax:914-946-1177
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00724-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist