Provider Demographics
NPI:1467834747
Name:LICHTENSTEIN, DALE SUSAN
Entity Type:Individual
Prefix:MRS
First Name:DALE
Middle Name:SUSAN
Last Name:LICHTENSTEIN
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 1:5 ADAMS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518-1511
Mailing Address - Country:US
Mailing Address - Phone:914-441-1723
Mailing Address - Fax:
Practice Address - Street 1:5 ADAMS HILL RD
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518-1511
Practice Address - Country:US
Practice Address - Phone:914-441-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 003170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist