Provider Demographics
NPI:1568510345
Name:BAILEY-VISCONTI, MELISSA L (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:BAILEY-VISCONTI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1322
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08362-1322
Mailing Address - Country:US
Mailing Address - Phone:609-634-4640
Mailing Address - Fax:
Practice Address - Street 1:718 E LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8011
Practice Address - Country:US
Practice Address - Phone:856-690-8940
Practice Address - Fax:856-690-8980
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052547001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical