Provider Demographics
NPI:1285946384
Name:MITTELMAN, CHANIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CHANIE
Middle Name:
Last Name:MITTELMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 49TH ST
Mailing Address - Street 2:6G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3254
Mailing Address - Country:US
Mailing Address - Phone:718-851-4129
Mailing Address - Fax:
Practice Address - Street 1:1528 49TH ST
Practice Address - Street 2:6G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3254
Practice Address - Country:US
Practice Address - Phone:718-851-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist