Provider Demographics
NPI:1639584592
Name:DE OLEO, ROBERTA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:
Last Name:DE OLEO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:VENUTOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:17 CUMBERLAND CT
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1456
Mailing Address - Country:US
Mailing Address - Phone:732-887-2125
Mailing Address - Fax:
Practice Address - Street 1:17 CUMBERLAND CT
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1456
Practice Address - Country:US
Practice Address - Phone:732-659-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00701800101YM0800X
NJ101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31-4011OtherMEDICARE
NJ4144007Medicaid