Provider Demographics
NPI:1689829228
Name:DABAH, DALIA R (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DALIA
Middle Name:R
Last Name:DABAH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3353 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4003
Practice Address - Country:US
Practice Address - Phone:718-646-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2010-10-19
Deactivation Date:2009-11-04
Deactivation Code:
Reactivation Date:2010-10-19
Provider Licenses
StateLicense IDTaxonomies
NY018513235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018513OtherNEW YORK STATE LICENSE AS SPEECH-LANGUAGE PATHOLOGIST