Provider Demographics
NPI:1053189886
Name:ZACHARIADES, LORENA FRIEDA (MT-BC)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:FRIEDA
Last Name:ZACHARIADES
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:FRIEDA
Other - Last Name:LIMATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:2050 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2742
Mailing Address - Country:US
Mailing Address - Phone:610-449-9669
Mailing Address - Fax:610-449-5566
Practice Address - Street 1:472 BLAIR MILL ROAD
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:19040-4397
Practice Address - Country:US
Practice Address - Phone:215-443-9669
Practice Address - Fax:215-443-5566
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA18031225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist