Provider Demographics
NPI:1811519168
Name:PERILLO, ELIZABETH F (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:PERILLO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DIANE CT FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2105
Mailing Address - Country:US
Mailing Address - Phone:201-787-0297
Mailing Address - Fax:
Practice Address - Street 1:12 DIANE CT FL 2
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-2105
Practice Address - Country:US
Practice Address - Phone:201-787-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-09
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01030800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist