Provider Demographics
NPI:1811164700
Name:MEANCE, GHISLENE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GHISLENE
Middle Name:
Last Name:MEANCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 MORRIS AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-3616
Mailing Address - Country:US
Mailing Address - Phone:973-652-2753
Mailing Address - Fax:
Practice Address - Street 1:371 MORRIS AVE FL 2
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-3616
Practice Address - Country:US
Practice Address - Phone:908-737-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017629103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical