Healthcare Provider Details

I. General information

NPI: 1477177368
Provider Name (Legal Business Name): GAIL ROFFE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WOODPORT RD STE B
SPARTA NJ
07871-2628
US

IV. Provider business mailing address

30 HIDDEN GLEN DR
SPARTA NJ
07871-3800
US

V. Phone/Fax

Practice location:
  • Phone: 973-726-3772
  • Fax:
Mailing address:
  • Phone: 973-512-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05926800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: