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General NPI Number Information
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NPI Number | 1093465627
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Entity Type | Individual
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Provider Name | VANESSA LABRUZZA LAC
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Gender | Female
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Dates
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Enumeration Date | 03/26/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 276 EAST MAIN STREET SUITE 10 #425
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City | DENVILLE
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State | NJ
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Zip | 07834
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Country | US
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Telephone | 201-639-4046
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Fax |
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Provider Business Mailing Address
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Address Line | 27 MAJESTIC DR
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City | FREEHOLD
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State | NJ
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Zip | 07728-1471
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Country | US
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Telephone | 732-239-3287
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | NJ
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