Provider Demographics
NPI:1831405026
Name:CAMEN, MIA L (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MIA
Middle Name:L
Last Name:CAMEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 UNDERHILL AVE.
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:NY
Mailing Address - Zip Code:11575-2334
Mailing Address - Country:US
Mailing Address - Phone:516-345-7500
Mailing Address - Fax:
Practice Address - Street 1:60 UNDERHILL AVE.
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-2334
Practice Address - Country:US
Practice Address - Phone:516-345-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014910235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist