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General NPI Number Information
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NPI Number | 1255944252
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Entity Type | Individual
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Provider Name | LAKEITHA TRADELL BRANCH LAC
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Gender | Female
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 275 BLOOMFIELD AVE STE 4
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City | CALDWELL
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State | NJ
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Zip | 07006-5100
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Country | US
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Telephone | 862-206-7232
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Fax | 973-860-0717
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Provider Business Mailing Address
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Address Line | 732 AVENUE E APT 411
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City | BAYONNE
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State | NJ
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Zip | 07002-4392
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Country | US
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Telephone | 347-351-8441
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 37AC00283900
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License Number State | NJ
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