Healthcare Provider Details

I. General information

NPI: 1447108303
Provider Name (Legal Business Name): BRIANNA REYES LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BLOOMFIELD AVE STE 102
CALDWELL NJ
07006-5167
US

IV. Provider business mailing address

105 LAKEWOOD AVE
CEDAR GROVE NJ
07009-1552
US

V. Phone/Fax

Practice location:
  • Phone: 973-898-5892
  • Fax:
Mailing address:
  • Phone: 973-803-3496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00944600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: