Provider Demographics
NPI:1508148875
Name:MISKULIN, ALLISON LEE (LCADC, LPC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEE
Last Name:MISKULIN
Suffix:
Gender:F
Credentials:LCADC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MUSCONETCONG AVE
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-2939
Mailing Address - Country:US
Mailing Address - Phone:973-699-4918
Mailing Address - Fax:
Practice Address - Street 1:64 MUSCONETCONG AVE
Practice Address - Street 2:
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874-2939
Practice Address - Country:US
Practice Address - Phone:973-699-4918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00160800101YA0400X
NJ37PC00286000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4138601Medicaid
NJ4138601Medicaid