Provider Demographics
NPI:1891399614
Name:BRODEUR, RIO (LPC)
Entity Type:Individual
Prefix:
First Name:RIO
Middle Name:
Last Name:BRODEUR
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 1:1703 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1113
Mailing Address - Country:US
Mailing Address - Phone:609-694-0639
Mailing Address - Fax:
Practice Address - Street 1:1930 MARLTON PIKE E STE T
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-4217
Practice Address - Country:US
Practice Address - Phone:609-405-6787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00474200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional