Healthcare Provider Details

I. General information

NPI: 1245903228
Provider Name (Legal Business Name): RIELLE MARIE HAMBROSE LPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STATE ROUTE 35
CLIFFWOOD NJ
07721-1512
US

IV. Provider business mailing address

28 WHEATSHEAF RD
CLARK NJ
07066-2734
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-2555
  • Fax:
Mailing address:
  • Phone: 732-857-0980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00781000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00335200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: