Provider Demographics
NPI:1881265023
Name:PETERS, MELANIE ANN (LPC, ATR-BC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ANN
Last Name:PETERS
Suffix:
Gender:F
Credentials:LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 HONEYBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-2913
Mailing Address - Country:US
Mailing Address - Phone:908-319-9684
Mailing Address - Fax:
Practice Address - Street 1:11 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3577
Practice Address - Country:US
Practice Address - Phone:908-522-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18-187221700000X
NJ37PC00771700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist