Provider Demographics
NPI:1972350254
Name:AVELINO, PATRICIA
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:AVELINO
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 1:79 BLACKBURN PL
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2303
Mailing Address - Country:US
Mailing Address - Phone:917-513-0902
Mailing Address - Fax:
Practice Address - Street 1:50 KNOLL DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4024
Practice Address - Country:US
Practice Address - Phone:973-664-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SLO6666200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker