Individual
ELEONORA TAVELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NCC, LAC
Contact information
Practice address
15 W PROSPECT ST, EAST BRUNSWICK, NJ 08816-2161
(732) 254-0600
Mailing address
41 COLUMBIA AVE, COLONIA, NJ 07067-2805
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37AC00325200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260732917
OTHER
NJ
Enumeration date
07/31/2017
Last updated
07/31/2017
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