Provider Demographics
NPI:1609497080
Name:SIRAGUSA, MELISSA (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SIRAGUSA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2119
Mailing Address - Country:US
Mailing Address - Phone:914-338-6081
Mailing Address - Fax:201-343-4391
Practice Address - Street 1:5 PASCACK RD
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07677-8317
Practice Address - Country:US
Practice Address - Phone:914-338-6081
Practice Address - Fax:201-343-4391
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00521800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health