Provider Demographics
NPI:1063877686
Name:FIDEL, LOVERTON (MA, MS, MBA)
Entity type:Individual
Prefix:PROF
First Name:LOVERTON
Middle Name:
Last Name:FIDEL
Suffix:
Gender:M
Credentials:MA, MS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1538
Mailing Address - Country:US
Mailing Address - Phone:732-247-6263
Mailing Address - Fax:
Practice Address - Street 1:169 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4105
Practice Address - Country:US
Practice Address - Phone:732-247-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00245600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor