Provider Demographics
NPI:1003582248
Name:MORITZ, SAMARA YAEL (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:YAEL
Last Name:MORITZ
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2725
Mailing Address - Country:US
Mailing Address - Phone:201-835-4227
Mailing Address - Fax:
Practice Address - Street 1:110 HILLSIDE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3932
Practice Address - Country:US
Practice Address - Phone:848-285-5065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist