Healthcare Provider Details

I. General information

NPI: 1487469128
Provider Name (Legal Business Name): JASON ROVETTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MAIN ST
CHATHAM NJ
07928-2425
US

IV. Provider business mailing address

31 REGER RD
SUCCASUNNA NJ
07876-1068
US

V. Phone/Fax

Practice location:
  • Phone: 973-635-6550
  • Fax:
Mailing address:
  • Phone: 201-873-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00570800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: