Individual
PATRICK JOHN REVELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC
Contact information
Practice address
14 MAIN ST, SPARTA, NJ 07871-1948
(201) 498-9140
Mailing address
14 MAIN ST, SPARTA, NJ 07871-1948
(201) 498-9140
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
37PC00601200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0023701
AGENCY PROVIDER #
NJ
01
—
7794703
AGENCY PROGRAM PROVIDER #
NJ
Enumeration date
09/10/2012
Last updated
01/17/2025
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