Healthcare Provider Details

I. General information

NPI: 1063106573
Provider Name (Legal Business Name): HANNAH ELIZABETH RIEDE LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ESSEX ST STE 110
HACKENSACK NJ
07601-4034
US

IV. Provider business mailing address

534 SUNSET AVE
HAWORTH NJ
07641-1728
US

V. Phone/Fax

Practice location:
  • Phone: 201-488-6678
  • Fax:
Mailing address:
  • Phone: 201-803-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00714600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: