Provider Demographics
NPI:1013430719
Name:RESNICK, MICHELE REBECCA (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:REBECCA
Last Name:RESNICK
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 1:128 DIMMIG RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2205
Mailing Address - Country:US
Mailing Address - Phone:917-502-0129
Mailing Address - Fax:
Practice Address - Street 1:128 DIMMIG ROAD
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458
Practice Address - Country:US
Practice Address - Phone:917-502-0129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051077001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical