Provider Demographics
NPI:1689885899
Name:MISITO, MARIA ELENA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA ELENA
Middle Name:
Last Name:MISITO
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 1:227 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1847
Mailing Address - Country:US
Mailing Address - Phone:973-903-1109
Mailing Address - Fax:
Practice Address - Street 1:227 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1847
Practice Address - Country:US
Practice Address - Phone:973-903-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052812000102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst