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
State | License ID | Taxonomies |
---|---|---|
NJ | 37LC00160800 | 101YA0400X |
NJ | 37PC00286000 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 4138601 | Medicaid | |
NJ | 4138601 | Medicaid |