Healthcare Provider Details

I. General information

NPI: 1750624607
Provider Name (Legal Business Name): TAM LE ROVITTO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 06/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SENIOR ST
NEW BRUNSWICK NJ
08901-8534
US

IV. Provider business mailing address

17 SENIOR ST
NEW BRUNSWICK NJ
08901-8534
US

V. Phone/Fax

Practice location:
  • Phone: 848-228-0775
  • Fax:
Mailing address:
  • Phone: 848-228-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079380-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05545800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: