Provider Demographics
NPI:1376161596
Name:RELLA, JUSTINE (LICENSE PROFESSIONAL)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:RELLA
Suffix:
Gender:F
Credentials:LICENSE PROFESSIONAL
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:RELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSE PROFESSIONAL
Mailing Address - Street 1:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-0924
Mailing Address - Country:US
Mailing Address - Phone:201-528-5757
Mailing Address - Fax:973-200-8137
Practice Address - Street 1:151 W PASSAIC ST STE 30
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3105
Practice Address - Country:US
Practice Address - Phone:201-528-5757
Practice Address - Fax:973-200-8137
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00688000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional