Healthcare Provider Details

I. General information

NPI: 1568142701
Provider Name (Legal Business Name): STEPHANIE ROVELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SPEEDWELL AVE
MORRIS PLAINS NJ
07950-2132
US

IV. Provider business mailing address

659 EAGLE ROCK AVE STE 4
WEST ORANGE NJ
07052-2138
US

V. Phone/Fax

Practice location:
  • Phone: 201-494-6270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00653400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: