Provider Demographics
NPI:1922325158
Name:PANETH, NAOMI (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:
Last Name:PANETH
Suffix:
Gender:F
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 1:132 HADASSAH LANE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5560
Mailing Address - Country:US
Mailing Address - Phone:347-729-8445
Mailing Address - Fax:
Practice Address - Street 1:132 HADASSAH LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5560
Practice Address - Country:US
Practice Address - Phone:347-729-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015627-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist