Provider Demographics
NPI:1710058102
Name:ABRAHAM, SUZANNE S (PHD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:S
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 14TH RD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2609
Mailing Address - Country:US
Mailing Address - Phone:718-767-0091
Mailing Address - Fax:715-767-0086
Practice Address - Street 1:120 MINEOLA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4064
Practice Address - Country:US
Practice Address - Phone:516-663-4600
Practice Address - Fax:516-663-8297
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006416235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist