Provider Demographics
NPI:1720021538
Name:NERO, RICHARD E (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:NERO
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 PIKES HL
Mailing Address - Street 2:SUITE 69
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5321
Mailing Address - Country:US
Mailing Address - Phone:207-744-0107
Mailing Address - Fax:207-744-0520
Practice Address - Street 1:78 PIKES HL
Practice Address - Street 2:SUITE 69
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5321
Practice Address - Country:US
Practice Address - Phone:207-744-0107
Practice Address - Fax:207-744-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP636235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME218530000Medicaid
ME218530000Medicaid