Provider Demographics
NPI:1689417099
Name:BORRERO-TAVAREZ, CAROLINE (MS)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:BORRERO-TAVAREZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 SAUNDERS ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4205
Mailing Address - Country:US
Mailing Address - Phone:917-584-0787
Mailing Address - Fax:
Practice Address - Street 1:13056 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-1841
Practice Address - Country:US
Practice Address - Phone:917-584-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034089-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist