Provider Demographics
NPI:1346337870
Name:KAVANAGH, SUSAN H (MS CCC/A)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:H
Last Name:KAVANAGH
Suffix:
Gender:F
Credentials:MS CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 4TH ST
Mailing Address - Street 2:APT.#2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7229
Mailing Address - Country:US
Mailing Address - Phone:212-777-4966
Mailing Address - Fax:212-777-7575
Practice Address - Street 1:115 CHAMBERS ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1001
Practice Address - Country:US
Practice Address - Phone:212-791-2126
Practice Address - Fax:212-406-4765
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001927-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist