Provider Demographics
NPI:1295589406
Name:ANGERVIL, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:ANGERVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 S 19TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07108-1110
Mailing Address - Country:US
Mailing Address - Phone:732-379-1214
Mailing Address - Fax:
Practice Address - Street 1:816 S 19TH ST APT 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07108-1110
Practice Address - Country:US
Practice Address - Phone:732-379-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty