Provider Demographics
NPI:1699842153
Name:DEARING, MAE LUCILLE EBARDO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MAE LUCILLE
Middle Name:EBARDO
Last Name:DEARING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MAE LUCILLE
Other - Middle Name:LABAO
Other - Last Name:EBARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:219 SCHERRER ST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2526
Mailing Address - Country:US
Mailing Address - Phone:551-998-6651
Mailing Address - Fax:
Practice Address - Street 1:574 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1001
Practice Address - Country:US
Practice Address - Phone:908-228-3632
Practice Address - Fax:908-228-3631
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01122400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist