Provider Demographics
NPI:1295598746
Name:NUNEZ, MILISSEN (MA, LPC)
Entity type:Individual
Prefix:
First Name:MILISSEN
Middle Name:
Last Name:NUNEZ
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 GREGORY LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-9583
Mailing Address - Country:US
Mailing Address - Phone:917-783-0408
Mailing Address - Fax:
Practice Address - Street 1:1800 JOHN F KENNEDY BLVD STE 1404
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-7417
Practice Address - Country:US
Practice Address - Phone:855-675-4010
Practice Address - Fax:617-807-0958
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC018268101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health