Healthcare Provider Details

I. General information

NPI: 1801062211
Provider Name (Legal Business Name): ANTHONY THOMAS RUVOLO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAKE ST STE C8
RAMSEY NJ
07446-1249
US

IV. Provider business mailing address

19 SPEAR ROAD SUITE #312
RAMSEY NJ
07446
US

V. Phone/Fax

Practice location:
  • Phone: 201-259-4037
  • Fax: 201-825-7550
Mailing address:
  • Phone: 201-259-4037
  • Fax: 201-825-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37PC00064800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00064800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: