Healthcare Provider Details

I. General information

NPI: 1477910388
Provider Name (Legal Business Name): TRACI BITONDO LPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRACI BITONDO-STENAVAGE ATR-BC

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 W MAIN ST
ROCKAWAY NJ
07866-3319
US

IV. Provider business mailing address

171 W MAIN ST
ROCKAWAY NJ
07866-3319
US

V. Phone/Fax

Practice location:
  • Phone: 973-370-3006
  • Fax:
Mailing address:
  • Phone: 973-370-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00575700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number15098
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: