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General NPI Number Information
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NPI Number | 1417416934
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Entity Type | Individual
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Provider Name | LORALEE FARREN-BERMUDEZ M.A.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 137 EGG HARBOR RD STE H
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City | SEWELL
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State | NJ
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Zip | 08080-9404
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Country | US
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Telephone | 609-221-4179
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Fax |
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Provider Business Mailing Address
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Address Line | 205 JAMESTOWN BLVD
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City | HAMMONTON
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State | NJ
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Zip | 08037-2111
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Country | US
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Telephone | 609-832-2820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS00455500
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License Number State | NJ
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