Healthcare Provider Details

I. General information

NPI: 1700856887
Provider Name (Legal Business Name): VANESSA K ROZZELLE M.A., M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 IRVING ST
RAHWAY NJ
07065-4032
US

IV. Provider business mailing address

250 STANTON ST
RAHWAY NJ
07065-3124
US

V. Phone/Fax

Practice location:
  • Phone: 732-340-9393
  • Fax: 732-340-9519
Mailing address:
  • Phone: 732-340-9393
  • Fax: 732-340-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00284700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: