Provider Demographics
NPI:1942670278
Name:ROSEVELT, ALLISON (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:
Last Name:ROSEVELT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CHEWS LANDING RD
Mailing Address - Street 2:SUITE 49
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2769
Mailing Address - Country:US
Mailing Address - Phone:856-248-0184
Mailing Address - Fax:
Practice Address - Street 1:1405 CHEWS LANDING RD
Practice Address - Street 2:SUITE 49
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2769
Practice Address - Country:US
Practice Address - Phone:856-248-0184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00177088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist