Provider Demographics
NPI:1760653604
Name:HADESHIAN, CATHERINE MARIE (MA, CCC-A, F-AAA)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARIE
Last Name:HADESHIAN
Suffix:
Gender:F
Credentials:MA, CCC-A, F-AAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WATERS PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-863-4366
Mailing Address - Fax:718-863-9743
Practice Address - Street 1:560 WHITE PLAINS RD - SUITE 560
Practice Address - Street 2:ENTA
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5112
Practice Address - Country:US
Practice Address - Phone:914-984-2534
Practice Address - Fax:914-358-0504
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001573-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400001555Medicare PIN