Provider Demographics
NPI:1356895783
Name:CASTELLUCCIO DE DIESBACH, CATHARINE AMARA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CATHARINE
Middle Name:AMARA
Last Name:CASTELLUCCIO DE DIESBACH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:CATHARINE
Other - Middle Name:A
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:25 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2610
Mailing Address - Country:US
Mailing Address - Phone:845-201-8362
Mailing Address - Fax:
Practice Address - Street 1:25 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2610
Practice Address - Country:US
Practice Address - Phone:845-201-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010928-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist