Healthcare Provider Details

I. General information

NPI: 1821952151
Provider Name (Legal Business Name): RYAN PAOLICELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 US 9 STE 5B
FREEHOLD NJ
07728-8305
US

IV. Provider business mailing address

329 E JIMMIE LEEDS RD STE 101
GALLOWAY NJ
08205-4110
US

V. Phone/Fax

Practice location:
  • Phone: 609-901-3350
  • Fax:
Mailing address:
  • Phone: 609-241-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01212600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: