Healthcare Provider Details

I. General information

NPI: 1619752201
Provider Name (Legal Business Name): ADVANCED RAW ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 RIDGEDALE AVE STE 200
FLORHAM PARK NJ
07932-1349
US

IV. Provider business mailing address

205 RIDGEDALE AVE STE 200
FLORHAM PARK NJ
07932-1349
US

V. Phone/Fax

Practice location:
  • Phone: 732-231-5180
  • Fax: 732-231-5189
Mailing address:
  • Phone: 732-231-5180
  • Fax: 732-231-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL R LAVELLA JR.
Title or Position: FOUNDER DIRECTOR
Credential: MA, LPC, LCADC
Phone: 732-407-2653