Provider Demographics
NPI:1497194880
Name:HAFITZ, JEREMIE (MS, MPHIL, CCC)
Entity Type:Individual
Prefix:MS
First Name:JEREMIE
Middle Name:
Last Name:HAFITZ
Suffix:
Gender:F
Credentials:MS, MPHIL, CCC
Other - Prefix:MRS
Other - First Name:MIRIAM
Other - Middle Name:J
Other - Last Name:HAFITZ-ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MPHIL
Mailing Address - Street 1:27 WILDWOOD TER
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-2310
Mailing Address - Country:US
Mailing Address - Phone:973-743-6032
Mailing Address - Fax:
Practice Address - Street 1:27 WILDWOOD TER
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-2310
Practice Address - Country:US
Practice Address - Phone:973-743-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00242100235Z00000X
NY003095-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist