Provider Demographics
NPI:1568519056
Name:ADESSA, MELISSA PATRICE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:PATRICE
Last Name:ADESSA
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 1:14 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110
Mailing Address - Country:US
Mailing Address - Phone:201-488-6543
Mailing Address - Fax:201-488-6543
Practice Address - Street 1:218 ROUTE 17 NORTH
Practice Address - Street 2:SUITE 303
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662
Practice Address - Country:US
Practice Address - Phone:201-488-6543
Practice Address - Fax:201-488-6916
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048119001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ038086Medicare PIN