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NPI Code Detail

MEDICARE: BRIELLE WILEY LAC

MEDICARE: BRIELLE WILEY LAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor37AC00684000NJ

General Provider Information

NPI Number : 1205528320
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIELLE WILEY LAC
Provider Business Mailing Address
First Line : 105 CRAWFORD ST
Second Line :
City : EAST ORANGE
State : NJ
Zip : 07018-1810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 343 OLD GEORGES RD
Second Line :
City : NORTH BRUNSWICK
State : NJ
Zip : 08902-4801
Country : US
Telephone Number : 732-982-2888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2023
Last Update Date : 06/26/2023

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Directions to “ BRIELLE WILEY LAC” Practice Location

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