Provider Demographics
NPI:1407228372
Name:PASTULA, MELISSA (LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PASTULA
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 1:55 E SHAWNEE TRL
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07885-2927
Mailing Address - Country:US
Mailing Address - Phone:973-713-6063
Mailing Address - Fax:
Practice Address - Street 1:122 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2052
Practice Address - Country:US
Practice Address - Phone:973-713-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00534900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional