Provider Demographics
NPI:1407522840
Name:PERLMUTTER, OLIVIA JANE (MS)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JANE
Last Name:PERLMUTTER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 STAFFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1313
Mailing Address - Country:US
Mailing Address - Phone:973-580-1304
Mailing Address - Fax:
Practice Address - Street 1:151 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2813
Practice Address - Country:US
Practice Address - Phone:908-598-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist