Provider Demographics
NPI:1861849408
Name:HERELLE, MEGAN (LAMFT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HERELLE
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 TIDEWATER ST APT 3C
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-7374
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3322 US HIGHWAY 22 STE 1401
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-4407
Practice Address - Country:US
Practice Address - Phone:908-242-3634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 390200000X
NJ37FA00039400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251B00000XAgenciesCase Management
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program