Provider Demographics
NPI:1710572144
Name:HENAO, MELISSA (LAC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HENAO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 SHALER AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-2013
Mailing Address - Country:US
Mailing Address - Phone:201-851-2254
Mailing Address - Fax:
Practice Address - Street 1:88 ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SKILLMAN
Practice Address - State:NJ
Practice Address - Zip Code:08558-2642
Practice Address - Country:US
Practice Address - Phone:347-688-9837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
37AC00557700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health