Provider Demographics
NPI:1568947794
Name:AARON, BRIELLE (LAC)
Entity Type:Individual
Prefix:
First Name:BRIELLE
Middle Name:
Last Name:AARON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SALVATORE CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-5645
Mailing Address - Country:US
Mailing Address - Phone:908-285-0044
Mailing Address - Fax:
Practice Address - Street 1:1 W CLIFF ST FL 1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-1901
Practice Address - Country:US
Practice Address - Phone:908-399-9024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00412100103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46-1345010OtherCOURTNEY BATTISTA