Healthcare Provider Details

I. General information

NPI: 1083754493
Provider Name (Legal Business Name): RALPH DANIEL DELL'AQUILA ED.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BELLEVILLE AVE
BLOOMFIELD NJ
07003-3589
US

IV. Provider business mailing address

206 BELLEVILLE AVE
BLOOMFIELD NJ
07003-3589
US

V. Phone/Fax

Practice location:
  • Phone: 973-632-0269
  • Fax:
Mailing address:
  • Phone: 973-632-0269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00129700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC57
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00495600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: