Provider Demographics
NPI:1780976944
Name:MITCHELL, MELANIE (LCSW)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3324
Mailing Address - Country:US
Mailing Address - Phone:732-363-6655
Mailing Address - Fax:732-901-0277
Practice Address - Street 1:301 LAKEHURST RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7335
Practice Address - Country:US
Practice Address - Phone:732-552-0377
Practice Address - Fax:732-552-0378
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052204001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical