Provider Demographics
NPI:1679928758
Name:MELO, MARISTELA NORMANDO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARISTELA
Middle Name:NORMANDO
Last Name:MELO
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 1:2204 MORRIS AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5921
Mailing Address - Country:US
Mailing Address - Phone:908-851-0148
Mailing Address - Fax:908-688-4841
Practice Address - Street 1:2204 MORRIS AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5918
Practice Address - Country:US
Practice Address - Phone:908-851-0148
Practice Address - Fax:908-688-4841
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC012876001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical