Provider Demographics
NPI:1316278773
Name:DEFUSCO, ELIZABETH (MS, CCC, LDTC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DEFUSCO
Suffix:
Gender:F
Credentials:MS, CCC, LDTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 TAYLORS MILLS RD
Mailing Address - Street 2:SUITE 106 A
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3281
Mailing Address - Country:US
Mailing Address - Phone:732-780-5060
Mailing Address - Fax:732-462-0992
Practice Address - Street 1:224 TAYLORS MILLS RD
Practice Address - Street 2:SUITE 106 A
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3281
Practice Address - Country:US
Practice Address - Phone:732-780-5060
Practice Address - Fax:732-462-0992
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00056700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist