Provider Demographics
NPI:1336627058
Name:CAMANO, MELISSA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CAMANO
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:64 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NJ
Practice Address - Zip Code:07506-1228
Practice Address - Country:US
Practice Address - Phone:862-249-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2023-01-06
Deactivation Date:2018-10-10
Deactivation Code:
Reactivation Date:2018-10-17
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06402400104100000X
NJ44SC061593001041C0700X
NY105107104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker