Provider Demographics
NPI:1508244591
Name:MELLO, GRICEL (LPC)
Entity Type:Individual
Prefix:
First Name:GRICEL
Middle Name:
Last Name:MELLO
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 1:20 COMMERCE DR STE 135
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3614
Mailing Address - Country:US
Mailing Address - Phone:908-989-7473
Mailing Address - Fax:
Practice Address - Street 1:20 COMMERCE DR STE 135
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-3614
Practice Address - Country:US
Practice Address - Phone:908-989-7473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00601100101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional