Provider Demographics
NPI:1417183732
Name:O'MELIA, MICHELE ANNE (LPC)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:ANNE
Last Name:O'MELIA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2161
Mailing Address - Country:US
Mailing Address - Phone:732-269-3883
Mailing Address - Fax:
Practice Address - Street 1:210 W FRONT ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1155
Practice Address - Country:US
Practice Address - Phone:732-513-2776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00012300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional