Provider Demographics
NPI:1104205897
Name:LOPARDO-TAVERAS, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:LOPARDO-TAVERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EDGEWOOD TER
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2502
Mailing Address - Country:US
Mailing Address - Phone:908-655-5108
Mailing Address - Fax:
Practice Address - Street 1:20 EDGEWOOD TER
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2502
Practice Address - Country:US
Practice Address - Phone:908-655-5108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00425100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist