Provider Demographics
NPI:1619752201
Name:ADVANCED RAW ASSOCIATES LLC
Entity Type:Organization
Organization Name:ADVANCED RAW ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAVELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA, LPC, LCADC
Authorized Official - Phone:732-407-2653
Mailing Address - Street 1:205 RIDGEDALE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1349
Mailing Address - Country:US
Mailing Address - Phone:732-231-5180
Mailing Address - Fax:732-231-5189
Practice Address - Street 1:205 RIDGEDALE AVE STE 200
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1349
Practice Address - Country:US
Practice Address - Phone:732-231-5180
Practice Address - Fax:732-231-5189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NJ RECOVERY & WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty