Provider Demographics
NPI:1487196200
Name:LIU-MELITA, JENNY (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:LIU-MELITA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CRAIG PL
Mailing Address - Street 2:
Mailing Address - City:PENNSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08070-2310
Mailing Address - Country:US
Mailing Address - Phone:856-381-5935
Mailing Address - Fax:
Practice Address - Street 1:24 CRAIG PL
Practice Address - Street 2:
Practice Address - City:PENNSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08070-2310
Practice Address - Country:US
Practice Address - Phone:856-381-5935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00181300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist