MEDICARE: GAIL ROFFE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05926800	NJ

General Provider Information

NPI Number	:	1477177368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL ROFFE LCSW

Provider Business Mailing Address
First Line	:	30 HIDDEN GLEN DR
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-3800
Country	:	US
Telephone Number	:	973-512-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 WOODPORT RD STE B
Second Line	:
City	:	SPARTA
State	:	NJ
Zip	:	07871-2628
Country	:	US
Telephone Number	:	973-726-3772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	06/05/2020

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