Provider Demographics
NPI:1326365883
Name:MENA, MARYCLAIRE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARYCLAIRE
Middle Name:
Last Name:MENA
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 1:50 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1803
Mailing Address - Country:US
Mailing Address - Phone:201-358-6404
Mailing Address - Fax:201-358-6404
Practice Address - Street 1:50 BENSON AVE
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1803
Practice Address - Country:US
Practice Address - Phone:201-358-6404
Practice Address - Fax:201-358-6404
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001939001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2695417OtherOXFORD HEALTH CARE