Provider Demographics
NPI:1073517413
Name:CRESCENZO, WARREN L (MA, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:WARREN
Middle Name:L
Last Name:CRESCENZO
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 1:1104 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-3322
Mailing Address - Country:US
Mailing Address - Phone:856-696-3043
Mailing Address - Fax:
Practice Address - Street 1:1104 E PARK AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-3322
Practice Address - Country:US
Practice Address - Phone:856-696-3043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYS 00101800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist