Provider Demographics
NPI:1376199331
Name:LABODE-RICHMAN, VANESSA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:MARIE
Last Name:LABODE-RICHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 TAPPAN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2257
Mailing Address - Country:US
Mailing Address - Phone:551-580-2356
Mailing Address - Fax:
Practice Address - Street 1:190 TAPPAN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2257
Practice Address - Country:US
Practice Address - Phone:551-580-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S10061400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist