Provider Demographics
NPI:1881093896
Name:HOYLIE-RISTAINO, IRENE (LCADC, LAC, NCC)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:HOYLIE-RISTAINO
Suffix:
Gender:F
Credentials:LCADC, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 162
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-3333
Mailing Address - Country:US
Mailing Address - Phone:732-822-6520
Mailing Address - Fax:
Practice Address - Street 1:57 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 162
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-3333
Practice Address - Country:US
Practice Address - Phone:732-822-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00608300101YP2500X
NJ37LC00186200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional