Provider Demographics
NPI:1295340107
Name:DEBERNARDIS, LORRI (OT)
Entity type:Individual
Prefix:
First Name:LORRI
Middle Name:
Last Name:DEBERNARDIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1104
Mailing Address - Country:US
Mailing Address - Phone:732-962-5462
Mailing Address - Fax:
Practice Address - Street 1:1 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1104
Practice Address - Country:US
Practice Address - Phone:732-962-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00062500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist