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General NPI Number Information
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NPI Number | 1467834382
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Entity Type | Organization
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Legal Business Name | CEA SPEECH LANGUAGE PATHOLOGY
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Dates
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Enumeration Date | 06/27/2015
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Last Update Date | 06/27/2015
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Provider Practice Location Address
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Address Line | 887 OLD COUNTRY RD
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City | RIVERHEAD
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State | NY
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Zip | 11901-2115
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Country | US
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Telephone | 631-942-5209
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Fax | 631-458-1651
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Provider Business Mailing Address
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Address Line | 7 SHORE RD
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City | STONY BROOK
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State | NY
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Zip | 11790-1407
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Country | US
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Telephone | 631-942-5209
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Fax | 631-458-1651
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VERONICA CEA
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Credential | M.S. CCC/SLP
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Telephone | 631-942-5209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 013688
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License Number State | NY
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