Provider Demographics
NPI:1922138056
Name:BOILEAU, MELANIE WALKER (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:WALKER
Last Name:BOILEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HUMMINGBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-3012
Mailing Address - Country:US
Mailing Address - Phone:609-628-4374
Mailing Address - Fax:
Practice Address - Street 1:128 CREST HAVEN RD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1651
Practice Address - Country:US
Practice Address - Phone:609-465-4100
Practice Address - Fax:609-465-2588
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052676001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093396Medicare ID - Type Unspecified