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General NPI Number Information
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NPI Number | 1952882912
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Entity Type | Individual
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Provider Name | MEREDITH MARRA
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 11/20/2018
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Provider Practice Location Address
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Address Line | 1155 PLEASANT VALLEY WAY
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City | WEST ORANGE
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State | NJ
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Zip | 07052-1424
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Country | US
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Telephone | 973-800-2356
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Fax |
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Provider Business Mailing Address
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Address Line | 53 LIBERTY ST
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City | CLARK
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State | NJ
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Zip | 07066-1805
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Country | US
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Telephone | 973-800-2356
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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 | 41YS00772900
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License Number State | NJ
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