Provider Demographics
NPI:1285093427
Name:VALENTINO, SUSAN (MS;CCC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:VALENTINO
Suffix:
Gender:F
Credentials:MS;CCC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:ROWE-VALENTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS;CCC
Mailing Address - Street 1:P.O.B. 715
Mailing Address - Street 2:1 MORRISSEY LANE
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959-0715
Mailing Address - Country:US
Mailing Address - Phone:631-653-8411
Mailing Address - Fax:
Practice Address - Street 1:1 MORRISSEY LANE
Practice Address - Street 2:
Practice Address - City:QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11959-0715
Practice Address - Country:US
Practice Address - Phone:631-653-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0005288-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist