Provider Demographics
NPI:1881908408
Name:CEELY, SUSAN BARBRE (TSSH, MS)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BARBRE
Last Name:CEELY
Suffix:
Gender:F
Credentials:TSSH, MS
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:CEELY
Other - Last Name:PHILIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TSSH, MS
Mailing Address - Street 1:510 MAIN ST
Mailing Address - Street 2:# 736
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0101
Mailing Address - Country:US
Mailing Address - Phone:917-334-6168
Mailing Address - Fax:
Practice Address - Street 1:510 MAIN ST
Practice Address - Street 2:# 736
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10044-0101
Practice Address - Country:US
Practice Address - Phone:917-334-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006874-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist