MEDICARE: CAITLIN ELIZABETH CANESA M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	022134-1	NY
2	235Z00000X	Speech-Language Pathologist	022134	NY

General Provider Information

NPI Number	:	1295085421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN ELIZABETH CANESA M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	1060 EAST 95TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236
Country	:	US
Telephone Number	:	646-523-4423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 E 95TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-2032
Country	:	US
Telephone Number	:	646-523-4423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	04/22/2015

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Directions to “ CAITLIN ELIZABETH CANESA M.A. CCC-SLP” Practice Location

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