Provider Demographics
NPI:1083395685
Name:SIMONE, MELISSA NICOLE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:NICOLE
Last Name:SIMONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 GRAND PL
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-1842
Mailing Address - Country:US
Mailing Address - Phone:201-887-0754
Mailing Address - Fax:
Practice Address - Street 1:69 GRAND PL
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-1842
Practice Address - Country:US
Practice Address - Phone:201-887-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00627400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health