Provider Demographics
NPI:1164967329
Name:ROVITO, ANTHONY JR
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ROVITO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:J
Other - Last Name:ROVITO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:CASAC-G
Mailing Address - Street 1:987 R C HOAG DR
Mailing Address - Street 2:BEHAVIORAL HEALTH UNIT
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1365
Mailing Address - Country:US
Mailing Address - Phone:716-945-9001
Mailing Address - Fax:716-945-0790
Practice Address - Street 1:987 R C HOAG DR
Practice Address - Street 2:BEHAVIORAL HEALTH UNIT
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1365
Practice Address - Country:US
Practice Address - Phone:716-945-9001
Practice Address - Fax:716-945-0790
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6191101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)