Provider Demographics
NPI:1083756597
Name:MIGNECO, ELIZABETH A (MSW;LCSW;LMFT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:A
Last Name:MIGNECO
Suffix:
Gender:F
Credentials:MSW;LCSW;LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-1638
Mailing Address - Country:US
Mailing Address - Phone:908-276-1331
Mailing Address - Fax:
Practice Address - Street 1:1600 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3615
Practice Address - Country:US
Practice Address - Phone:908-873-1879
Practice Address - Fax:908-317-5459
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC015361041C0700X
NY0731511041C0700X
NJFI01238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY073151OtherLCSW
NJSC01536OtherLCSW
NJFI01238OtherMARRIAGE & FAMILY LICENSE
NJ205969Medicare UPIN
NJSC01536OtherLCSW
NJ000638989Medicare ID - Type UnspecifiedMSW
NJ5569262Medicare UPIN