Provider Demographics
NPI:1790893923
Name:MARCANTUONO, VANESSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:MARCANTUONO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:LOPRESTI-WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:108 MONMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757-1623
Mailing Address - Country:US
Mailing Address - Phone:732-483-6935
Mailing Address - Fax:
Practice Address - Street 1:12 RECKLESS PL
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1704
Practice Address - Country:US
Practice Address - Phone:973-652-1324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00411500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical