Active NPI
Patrick John Revello, MA, LPC
- Professional Counselor
- Sparta, NJ
National Provider Identifier
1245580976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 37PC00601200
- Practice address
- 14 Main St
Sparta, NJ 07871-1948 - Phone
- (201) 498-9140
- NPI assigned
- Sep 10, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | 37PC00601200 | NJ | Primary |
Addresses
Primary practice location
14 Main St
Sparta, NJ 07871-1948
Mailing address
14 Main St
Sparta, NJ 07871-1948
Phone (201) 498-9140
Other practice location 1
600 Coventry Dr
Phillipsburg, NJ 08865-1971
Phone (908) 454-4070
Other practice location 2
6 Dumont Pl
1st Floor
Morristown, NJ 07960-8104
Phone (908) 674-4438
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0023701 | Other | NJ | AGENCY PROVIDER # |
| 7794703 | Other | NJ | AGENCY PROGRAM PROVIDER # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37PC00601200 | NJ | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinical Psychotherapy & Consultation, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Phillipsburg, NJ
- NPI 1104294024
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737072000000",
"number": "1245580976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 MAIN ST",
"city": "SPARTA",
"state": "NJ",
"postal_code": "078711948",
"telephone_number": "201-498-9140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 MAIN ST",
"city": "SPARTA",
"state": "NJ",
"postal_code": "078711948",
"telephone_number": "201-498-9140"
}
],
"practiceLocations": [
{
"address_1": "600 Coventry Dr",
"address_purpose": "LOCATION",
"city": "Phillipsburg",
"state": "NJ",
"postal_code": "088651971",
"country_code": "US",
"telephone_number": "908-454-4070",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6 Dumont Pl",
"address_2": "1st Floor",
"address_purpose": "LOCATION",
"city": "Morristown",
"state": "NJ",
"postal_code": "079608104",
"country_code": "US",
"telephone_number": "908-674-4438",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "REVELLO",
"first_name": "PATRICK",
"middle_name": "JOHN",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-10",
"last_updated": "2025-01-17",
"certification_date": "2025-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37PC00601200",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AGENCY PROVIDER #",
"identifier": "0023701",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AGENCY PROGRAM PROVIDER #",
"identifier": "7794703",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sparta, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.