Provider Demographics
NPI:1902227457
Name:NIRENBERG, MICHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NIRENBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 HIGHWAY 35 STE 2
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1886
Mailing Address - Country:US
Mailing Address - Phone:630-884-9012
Mailing Address - Fax:
Practice Address - Street 1:117 HIGHWAY 35 STE 2
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1886
Practice Address - Country:US
Practice Address - Phone:630-884-9012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007141101YM0800X
GALPC006511101YM0800X
NJ37PC00565400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$Medicaid