Provider Demographics
NPI:1740681535
Name:MELISSA D ELLIOTT LCSW LLC
Entity type:Organization
Organization Name:MELISSA D ELLIOTT LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CGP
Authorized Official - Phone:201-446-4840
Mailing Address - Street 1:17 S FRANKLIN TPKE STE 3
Mailing Address - Street 2:
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446-2536
Mailing Address - Country:US
Mailing Address - Phone:201-446-4840
Mailing Address - Fax:
Practice Address - Street 1:17 S FRANKLIN TURNPIKE 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2552
Practice Address - Country:US
Practice Address - Phone:201-446-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05186600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty