Provider Demographics
NPI:1356985832
Name:RIDDELL, RENEE (LPC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:RIDDELL
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 1:1001 N BLACK HORSE PIKE APT B23
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1064
Mailing Address - Country:US
Mailing Address - Phone:609-617-9558
Mailing Address - Fax:
Practice Address - Street 1:1001 N BLACK HORSE PIKE APT B23
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1064
Practice Address - Country:US
Practice Address - Phone:609-617-9558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00487200101YM0800X
NJ37PC01078300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health