Provider Demographics
NPI:1528317336
Name:GOLDMAN, SUSAN BETH (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:BETH
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:51 FLORAL DRIVE WEST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-937-1278
Mailing Address - Fax:516-937-1278
Practice Address - Street 1:51 FLORAL DRIVE WEST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-937-1278
Practice Address - Fax:516-937-1278
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6445797235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist