Provider Demographics
NPI:1467760900
Name:DAMBMANN, SUSANNAH (MA)
Entity Type:Individual
Prefix:MS
First Name:SUSANNAH
Middle Name:
Last Name:DAMBMANN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 RIVERSIDE DR
Mailing Address - Street 2:APT 41
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-8516
Mailing Address - Country:US
Mailing Address - Phone:646-732-5175
Mailing Address - Fax:
Practice Address - Street 1:575 RIVERSIDE DR
Practice Address - Street 2:APT 41
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-8516
Practice Address - Country:US
Practice Address - Phone:646-732-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1808046235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist