Healthcare Provider Details

I. General information

NPI: 1821865874
Provider Name (Legal Business Name): ROBERTA GLEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 NORTHFIELD AVE
WEST ORANGE NJ
07052-3027
US

IV. Provider business mailing address

100 MARTIN LUTHER KING JR DR
JERSEY CITY NJ
07305-3024
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-3131
  • Fax:
Mailing address:
  • Phone: 201-616-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00946900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00946900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: