Provider Demographics
NPI:1740050467
Name:JEANNE MARIE MIRABELLA LLC
Entity type:Organization
Organization Name:JEANNE MARIE MIRABELLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND SERVICE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:908-247-5477
Mailing Address - Street 1:142 TIMBER DRIVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922
Mailing Address - Country:US
Mailing Address - Phone:908-247-5477
Mailing Address - Fax:
Practice Address - Street 1:308 SPRINGFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922
Practice Address - Country:US
Practice Address - Phone:908-247-5477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty