Provider Demographics
NPI:1083145270
Name:MARCELINO, LISA (MA, PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MARCELINO
Suffix:
Gender:F
Credentials:MA, PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2527
Mailing Address - Country:US
Mailing Address - Phone:732-877-9811
Mailing Address - Fax:
Practice Address - Street 1:3 CALVIN PL
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2450
Practice Address - Country:US
Practice Address - Phone:201-273-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT-842106H00000X
NJ37FI00216100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist