Healthcare Provider Details

I. General information

NPI: 1881308674
Provider Name (Legal Business Name): MELISSA LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ROBESON ST APT 256
SOMERVILLE NJ
08876-3290
US

IV. Provider business mailing address

200 GREENE ST APT 2005
JERSEY CITY NJ
07311-1442
US

V. Phone/Fax

Practice location:
  • Phone: 848-391-6360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00680300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: