Provider Demographics
NPI:1295185353
Name:VANESSA MARCANTUONO, PH.D., LLC
Entity Type:Organization
Organization Name:VANESSA MARCANTUONO, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCANTUONO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-652-1324
Mailing Address - Street 1:108 MONMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1623
Mailing Address - Country:US
Mailing Address - Phone:973-652-1324
Mailing Address - Fax:
Practice Address - Street 1:12 RECKLESS PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1704
Practice Address - Country:US
Practice Address - Phone:973-652-1324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00411500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty