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General NPI Number Information
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NPI Number | 1689137275
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Entity Type | Individual
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Provider Name | KAVELLE TRICIA MCGLASHAN BA, CADC INTERN
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Gender | Female
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 93 W PALISADE AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2611
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Country | US
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Telephone | 201-567-0500
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Fax | 201-567-9335
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Provider Business Mailing Address
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Address Line | 293 KINDERKAMACK RD APT B
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City | RIVER EDGE
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State | NJ
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Zip | 07661-1879
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Country | US
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Telephone | 201-888-5396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | NJ
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