Provider Demographics
NPI:1689812679
Name:PINO, MELISSA (LPC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:PINO
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 1:247 INTERLAKEN CT
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1875
Mailing Address - Country:US
Mailing Address - Phone:732-441-3452
Mailing Address - Fax:
Practice Address - Street 1:247 INTERLAKEN CT
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1875
Practice Address - Country:US
Practice Address - Phone:732-441-3452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00327200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional