Provider Demographics
NPI:1255038600
Name:SMITH, MELODY CANDA (,MA, LAC, NCC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:CANDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:,MA, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CALVIN PL
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2450
Mailing Address - Country:US
Mailing Address - Phone:732-654-2170
Mailing Address - Fax:
Practice Address - Street 1:3 CALVIN PL
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2450
Practice Address - Country:US
Practice Address - Phone:201-273-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00703700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health