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General NPI Number Information
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NPI Number | 1497411938
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Entity Type | Organization
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Legal Business Name | REVITALIZING REMEDIES LLC
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 11/09/2021
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Provider Practice Location Address
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Address Line | 52 NEWTON SPARTA RD STE 1
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City | ANDOVER
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State | NJ
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Zip | 07860-2723
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Country | US
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Telephone | 201-727-3241
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Fax | 201-727-3241
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Provider Business Mailing Address
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Address Line | 52 NEWTON SPARTA RD
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City | NEWTON
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State | NJ
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Zip | 07860-2723
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Country | US
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Telephone | 201-727-3241
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Fax | 201-727-3241
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Authorized Official
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Title or Position | OWNER/CLINICIAN PROVIDER
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Name | FIORELLA PARADISI
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Credential | APN
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Telephone | 201-727-3241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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