Provider Demographics
NPI:1720124050
Name:MATHEW, ELIZABETH CHENNIKARA (MS, CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CHENNIKARA
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MS, CCC SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1692 LINDEN ST
Mailing Address - Street 2:3
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2144
Mailing Address - Country:US
Mailing Address - Phone:914-330-1087
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:914-330-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0156141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist