Healthcare Provider Details

I. General information

NPI: 1053289314
Provider Name (Legal Business Name): MELISSA DICESARE-BAILEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 ORANGE TREE AVE
GALLOWAY NJ
08205-4519
US

IV. Provider business mailing address

336 ORANGE TREE AVE
GALLOWAY NJ
08205-4519
US

V. Phone/Fax

Practice location:
  • Phone: 609-464-2953
  • Fax: 609-464-2953
Mailing address:
  • Phone: 609-464-2953
  • Fax: 609-464-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00399500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: