Healthcare Provider Details

I. General information

NPI: 1548853021
Provider Name (Legal Business Name): LAVADA ROBIN BERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 GRAND AVE
ENGLEWOOD NJ
07631-3522
US

IV. Provider business mailing address

800 STATION DR APT 820
AVENEL NJ
07001-1875
US

V. Phone/Fax

Practice location:
  • Phone: 201-541-8600
  • Fax:
Mailing address:
  • Phone: 973-991-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: