Basic Information
| Provider Information | |||||||||
| NPI: | 1932250123 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANENTE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 935 BROAD ST | ||||||||
| Address2: | 25D | ||||||||
| City: | BLOOMFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070032841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015195428 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 19 HOLLY ST | ||||||||
| Address2: | |||||||||
| City: | CRANFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070162158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082727500 | ||||||||
| FaxNumber: | 9082727502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 37PC00343300 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.