Provider Demographics
NPI:1376730630
Name:CROCCO, SUSAN L (SLP SPEECH LANGUAGE)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:CROCCO
Suffix:
Gender:F
Credentials:SLP SPEECH LANGUAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 STONE HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589
Mailing Address - Country:US
Mailing Address - Phone:914-276-3775
Mailing Address - Fax:914-276-3137
Practice Address - Street 1:52 STONE HOUSE RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-2510
Practice Address - Country:US
Practice Address - Phone:914-276-3775
Practice Address - Fax:914-276-3137
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0066091235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist