Amanda Revilak, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

37PC00433700 Issued in NJ

Practice address

4 Marc Alton CT
Jackson, NJ 08527-4338

Phone

(908) 415-7636

NPI assigned

Oct 4, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Amanda Lowe Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1801511654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MARC ALTON CT",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085274338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MARC ALTON CT",
            "city": "JACKSON",
            "state": "NJ",
            "postal_code": "085274338",
            "telephone_number": "908-415-7636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVILAK",
        "first_name": "AMANDA",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NJ",
            "license": "37PC00433700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "LOWE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Professional Counselor in Jackson, NJ
• Providers in Jackson, NJ by specialty
• Professional Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.