Provider Demographics
NPI:1477910388
Name:BITONDO, TRACI (LPC, ATR-BC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:BITONDO
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:BITONDO-STENAVAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATR-BC
Mailing Address - Street 1:171 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-3319
Mailing Address - Country:US
Mailing Address - Phone:973-370-3006
Mailing Address - Fax:
Practice Address - Street 1:171 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-3319
Practice Address - Country:US
Practice Address - Phone:973-370-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15098221700000X
NJ37PC00575700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist