Provider Demographics
NPI:1215288394
Name:WEISEL, MELISSA (LSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WEISEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629-2220
Mailing Address - Country:US
Mailing Address - Phone:609-599-5433
Mailing Address - Fax:
Practice Address - Street 1:1435 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08629-2220
Practice Address - Country:US
Practice Address - Phone:609-599-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05749300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0169129Medicaid