Provider Demographics
NPI:1295079150
Name:MISCHENKO, NATALIE (MA, LCADC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MISCHENKO
Suffix:
Gender:F
Credentials:MA, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LAKE AVE
Mailing Address - Street 2:UNIT 31
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-1696
Mailing Address - Country:US
Mailing Address - Phone:732-403-6835
Mailing Address - Fax:
Practice Address - Street 1:1610 ROUTE 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3018
Practice Address - Country:US
Practice Address - Phone:732-403-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00180100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)