Provider Demographics
NPI:1285930131
Name:CANTOR-DIAZ, SUSAN HELENE (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HELENE
Last Name:CANTOR-DIAZ
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2619
Mailing Address - Country:US
Mailing Address - Phone:914-834-6421
Mailing Address - Fax:
Practice Address - Street 1:3051 E. TREMONT AVE.
Practice Address - Street 2:LIFESKILLS PRESCHOOL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-828-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004894-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist