Provider Demographics
NPI:1053848531
Name:RIDENTE, SALVATORE (LPC, EDS)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:RIDENTE
Suffix:
Gender:M
Credentials:LPC, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3508
Mailing Address - Country:US
Mailing Address - Phone:908-966-6927
Mailing Address - Fax:908-272-3566
Practice Address - Street 1:1 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3508
Practice Address - Country:US
Practice Address - Phone:908-966-6927
Practice Address - Fax:908-272-3566
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00586200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional