=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447108303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANNA REYES LAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2026
-----------------------------------------------------
Last Update Date | 03/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 DE MERCURIO DR STE 8
-----------------------------------------------------
City | ALLENDALE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07401-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-975-5196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 LAKEWOOD AVE
-----------------------------------------------------
City | CEDAR GROVE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07009-1552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-803-3496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37AC00944600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------