Provider Demographics
NPI:1760236947
Name:MELLON, DANA (LSW)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:MELLON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 VENUS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2423
Mailing Address - Country:US
Mailing Address - Phone:732-425-7281
Mailing Address - Fax:
Practice Address - Street 1:38 TAYLOR AVE STE 1
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3047
Practice Address - Country:US
Practice Address - Phone:732-612-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06946800104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker