Provider Demographics
NPI:1609588862
Name:SISTA, MARIA CARMEN (LPC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARMEN
Last Name:SISTA
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 1:75 MADISON TER
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3410
Mailing Address - Country:US
Mailing Address - Phone:908-400-9852
Mailing Address - Fax:
Practice Address - Street 1:75 MADISON TER
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3410
Practice Address - Country:US
Practice Address - Phone:908-400-9852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00400600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional