Provider Demographics
NPI:1932250123
Name:MANENTE, MELISSA M (LPC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:MANENTE
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 1:935 BROAD ST
Mailing Address - Street 2:25D
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2841
Mailing Address - Country:US
Mailing Address - Phone:201-519-5428
Mailing Address - Fax:
Practice Address - Street 1:19 HOLLY ST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2158
Practice Address - Country:US
Practice Address - Phone:908-272-7500
Practice Address - Fax:908-272-7502
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00343300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health