Provider Demographics
NPI:1245903228
Name:HAMBROSE, RIELLE MARIE (LPC, LCADC)
Entity type:Individual
Prefix:
First Name:RIELLE
Middle Name:MARIE
Last Name:HAMBROSE
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WHEATSHEAF RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2734
Mailing Address - Country:US
Mailing Address - Phone:732-857-0980
Mailing Address - Fax:
Practice Address - Street 1:111 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721-1512
Practice Address - Country:US
Practice Address - Phone:732-727-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NJ37PC00781000101YM0800X
NJ37LC00335200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty