Doctor Name: | ROBYERA REVOAL |
NPI Number: | 1194104844 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 37LC00217000 |
Business Practice Address: | 63 Albemarle Ave Ewing, NJ - 086383501 |
Business Phone Number: | 7327185214 |
Business Fax Number: | |
Mailing Address: | 63 Albemarle Ave, EWING |
State: | NJ |
Postal Code: | 086383501 |
Phone Number: | 7327185214 |
Fax Number: | |
NPI Enumeration Date: | 05/27/2015 |
NPI Last Update Date: | 05/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 37LC00217000 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |