Provider Demographics
NPI:1396423646
Name:REPIZO PAREDES, LUZ FERNANDA
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:FERNANDA
Last Name:REPIZO PAREDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 VETERANS AVE
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-0840
Mailing Address - Country:US
Mailing Address - Phone:607-664-4615
Mailing Address - Fax:607-664-4647
Practice Address - Street 1:76 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-0840
Practice Address - Country:US
Practice Address - Phone:607-664-4615
Practice Address - Fax:607-664-4647
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.117054104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty