Healthcare Provider Details

I. General information

NPI: 1164967329
Provider Name (Legal Business Name): ANTHONY ROVITO JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ANTHONY J ROVITO JR. CASAC-G

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 R C HOAG DR BEHAVIORAL HEALTH UNIT
SALAMANCA NY
14779-1365
US

IV. Provider business mailing address

987 R C HOAG DR BEHAVIORAL HEALTH UNIT
SALAMANCA NY
14779-1365
US

V. Phone/Fax

Practice location:
  • Phone: 716-945-9001
  • Fax: 716-945-0790
Mailing address:
  • Phone: 716-945-9001
  • Fax: 716-945-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: