Healthcare Provider Details

I. General information

NPI: 1245156462
Provider Name (Legal Business Name): JULIE COLLADO RIVERA LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 HAMBURG TPKE
WAYNE NJ
07470-3209
US

IV. Provider business mailing address

1022 HAMBURG TPKE
WAYNE NJ
07470-3209
US

V. Phone/Fax

Practice location:
  • Phone: 973-694-1234
  • Fax: 973-633-0992
Mailing address:
  • Phone: 973-694-1234
  • Fax: 973-633-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00973000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: