Provider Demographics
NPI:1760831572
Name:REID, RAUSHANAH (LPC)
Entity Type:Individual
Prefix:
First Name:RAUSHANAH
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 MAIN ST STE 205A
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5333
Mailing Address - Country:US
Mailing Address - Phone:973-325-3132
Mailing Address - Fax:973-789-9625
Practice Address - Street 1:59 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-5341
Practice Address - Country:US
Practice Address - Phone:973-325-3132
Practice Address - Fax:973-789-9625
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00509100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health