Provider Demographics
NPI:1083153944
Name:JEANNE MARIE MIRABELLA
Entity Type:Organization
Organization Name:JEANNE MARIE MIRABELLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:908-247-5477
Mailing Address - Street 1:308 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1278
Mailing Address - Country:US
Mailing Address - Phone:908-247-5477
Mailing Address - Fax:
Practice Address - Street 1:308 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1278
Practice Address - Country:US
Practice Address - Phone:908-247-5477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00027400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty