Provider Demographics
NPI:1174090138
Name:IMBRIALE, ALEXANDRIA (MA, LAC)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:IMBRIALE
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 TENNENT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3143
Mailing Address - Country:US
Mailing Address - Phone:732-851-7808
Mailing Address - Fax:
Practice Address - Street 1:600 TENNENT RD STE 104
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3143
Practice Address - Country:US
Practice Address - Phone:732-851-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00437600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health