Provider Demographics
NPI:1598004889
Name:MCCAN, EILEEN (MA)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:MCCAN
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 1:14951 16TH RD
Mailing Address - Street 2:WHITESTONE
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2537
Mailing Address - Country:US
Mailing Address - Phone:718-746-8741
Mailing Address - Fax:
Practice Address - Street 1:14951 16TH RD
Practice Address - Street 2:WHITESTONE
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2537
Practice Address - Country:US
Practice Address - Phone:917-608-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451585235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist