Provider Demographics
NPI:1215206677
Name:BRACCIOFORTE, MEGHAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:
Last Name:BRACCIOFORTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 CHURCH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1756
Mailing Address - Country:US
Mailing Address - Phone:973-940-0116
Mailing Address - Fax:973-940-0104
Practice Address - Street 1:18 CHURCH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1756
Practice Address - Country:US
Practice Address - Phone:973-940-0116
Practice Address - Fax:973-940-0104
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00437700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional