Provider Demographics
NPI:1457861692
Name:KERRI A. DIMICELI M.S. CCC-SLP, TSHH PLLC
Entity type:Organization
Organization Name:KERRI A. DIMICELI M.S. CCC-SLP, TSHH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIMICELI
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, TSHH
Authorized Official - Phone:914-434-0085
Mailing Address - Street 1:60 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4013
Practice Address - Country:US
Practice Address - Phone:914-434-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015623-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03722263Medicaid