Provider Demographics
NPI:1316572001
Name:ADDISU, MERON W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MERON
Middle Name:W
Last Name:ADDISU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 WARREN ST APT 3B
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2343
Mailing Address - Country:US
Mailing Address - Phone:201-680-1420
Mailing Address - Fax:
Practice Address - Street 1:300 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5429
Practice Address - Country:US
Practice Address - Phone:201-680-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05882500104100000X
NJ44SC061990001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker