Doctor Name: | ROMAN PETROCELLI |
NPI Number: | 1457678013 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | |
Business Practice Address: | 80 W Main St Mendham, NJ - 079451257 |
Business Phone Number: | 9735435656 |
Business Fax Number: | |
Mailing Address: | 80 W Main St, MENDHAM |
State: | NJ |
Postal Code: | 079451257 |
Phone Number: | 9735435656 |
Fax Number: | |
NPI Enumeration Date: | 04/22/2010 |
NPI Last Update Date: | 04/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |