Provider Demographics
NPI:1215288394
Name:WEISEL, MELISSA (LCSW, MSM PH-PP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WEISEL
Suffix:
Gender:F
Credentials:LCSW, MSM PH-PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-3033
Mailing Address - Country:US
Mailing Address - Phone:908-619-0464
Mailing Address - Fax:
Practice Address - Street 1:533 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3033
Practice Address - Country:US
Practice Address - Phone:908-619-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056731001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0169129Medicaid