Healthcare Provider Details

I. General information

NPI: 1629582721
Provider Name (Legal Business Name): MELLISSA ARENA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELLISSA SALVATORIELLO

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MICHIGAN AVE STE 3400
CHICAGO IL
60611-3980
US

IV. Provider business mailing address

671 HOES LANE
PISCATAWAY NJ
08855
US

V. Phone/Fax

Practice location:
  • Phone: 312-766-6780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00886900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: