Provider Demographics
NPI:1376067405
Name:CONELLI, CAITLIN MARY
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARY
Last Name:CONELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-2336
Mailing Address - Country:US
Mailing Address - Phone:516-424-5470
Mailing Address - Fax:
Practice Address - Street 1:322 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4529
Practice Address - Country:US
Practice Address - Phone:516-365-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist