Provider Demographics
NPI:1407443625
Name:CONQUEST, MELANIE (MA, CPRS)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:CONQUEST
Suffix:
Gender:F
Credentials:MA, CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 JEFFERSON ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5043
Mailing Address - Country:US
Mailing Address - Phone:630-479-2127
Mailing Address - Fax:
Practice Address - Street 1:19 JEFFERSON ST APT 4C
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5043
Practice Address - Country:US
Practice Address - Phone:630-479-2127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)