Provider Demographics
NPI:1134492044
Name:AMIGO, LUZ MARIA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:MARIA
Last Name:AMIGO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:MARIA
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2460 LEMOINE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6210
Mailing Address - Country:US
Mailing Address - Phone:201-970-1080
Mailing Address - Fax:201-944-0022
Practice Address - Street 1:2460 LEMOINE AVE STE 400
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6210
Practice Address - Country:US
Practice Address - Phone:201-970-1080
Practice Address - Fax:201-944-0022
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112811235Z00000X
NJ41YS00950000235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist