Provider Demographics
NPI:1841742798
Name:PRESTIS, VANESSA ANN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:PRESTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N WADE BLVD APT 307
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2219
Mailing Address - Country:US
Mailing Address - Phone:856-361-3360
Mailing Address - Fax:
Practice Address - Street 1:60 W LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8132
Practice Address - Country:US
Practice Address - Phone:856-772-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00752500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health