Provider Demographics
NPI:1295987576
Name:DUARTE, GEORGINA MERCEDES (SLP)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:MERCEDES
Last Name:DUARTE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18663
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33416-8663
Mailing Address - Country:US
Mailing Address - Phone:561-385-0073
Mailing Address - Fax:561-641-7704
Practice Address - Street 1:6120 FOREST HILL BLVD
Practice Address - Street 2:APT 209
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-5448
Practice Address - Country:US
Practice Address - Phone:561-385-0073
Practice Address - Fax:561-641-7704
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist