Provider Demographics
NPI:1861828246
Name:MIESAK, MARTA (MA)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:MIESAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 REHILL AVE
Mailing Address - Street 2:EMERGENCY ROOM SOMERSET MEDICAL CENTER
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2519
Mailing Address - Country:US
Mailing Address - Phone:908-526-4100
Mailing Address - Fax:908-526-0536
Practice Address - Street 1:27 WARREN ST
Practice Address - Street 2:HUMAN SERVICES - P.E.S.S.
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2921
Practice Address - Country:US
Practice Address - Phone:908-231-6475
Practice Address - Fax:908-526-0536
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS-4632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health