=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598269821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIBERTY SPEECH ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2018
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 256 STATE ROUTE 31 N
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07882-1550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-658-4400
-----------------------------------------------------
Fax | 908-509-6732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 555
-----------------------------------------------------
City | BLAIRSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07825-0555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-658-4400
-----------------------------------------------------
Fax | 908-362-1722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | COURTNEY CARUSO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-658-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------