MEDICARE: DR. ANTHONY THOMAS RUVOLO PHD

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	106H00000X	Marriage & Family Therapist	37PC00064800	NJ
2	101Y00000X	Counselor	37PC00064800	NJ

General Provider Information

NPI Number	:	1801062211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY THOMAS RUVOLO PHD

Provider Business Mailing Address
First Line	:	19 SPEAR ROAD
Second Line	:	SUITE #312
City	:	RAMSEY
State	:	NJ
Zip	:	07446
Country	:	US
Telephone Number	:	201-259-4037
Fax Number	:	201-825-7550

Provider Business Practice Location Address
First Line	:	1000 LAKE ST STE C8
Second Line	:
City	:	RAMSEY
State	:	NJ
Zip	:	07446-1249
Country	:	US
Telephone Number	:	201-259-4037
Fax Number	:	201-825-7550

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

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	06/20/2022

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