Provider Demographics
NPI:1184050759
Name:ROVELLO, SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROVELLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HILLSIDE CT
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-1051
Mailing Address - Country:US
Mailing Address - Phone:609-397-4173
Mailing Address - Fax:609-397-4403
Practice Address - Street 1:8 HILLSIDE CT
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08530-1051
Practice Address - Country:US
Practice Address - Phone:609-397-4173
Practice Address - Fax:609-397-4403
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC044361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical