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General NPI Number Information
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NPI Number | 1952889917
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Entity Type | Organization
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Legal Business Name | LUAR SPEECH THERAPEUTICS SERVICES
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Dates
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Enumeration Date | 08/01/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 439 ATLANTIC AVE
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518
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Country | US
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Telephone | 516-509-0912
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Fax |
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Provider Business Mailing Address
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Address Line | 439 ATLANTIC AVE
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518
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Country | US
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Telephone | 516-509-0912
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. LILLIBETH TAVAREZ
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Credential | M.S., CCC-SLP
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Telephone | 516-509-0912
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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 | 021260
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License Number State | NY
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