Provider Demographics
NPI:1295028827
Name:DUARTE, CAROLINE (SLP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:DUARTE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BEEHLER RD
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7663
Mailing Address - Country:US
Mailing Address - Phone:570-620-4346
Mailing Address - Fax:570-620-4342
Practice Address - Street 1:246 STADDEN RD STE 103
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372-7944
Practice Address - Country:US
Practice Address - Phone:570-620-4346
Practice Address - Fax:570-620-4342
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020645235Z00000X
PASL013272235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035895390002Medicaid