Healthcare Provider Details

I. General information

NPI: 1295598746
Provider Name (Legal Business Name): MILISSEN NUNEZ MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 JOHN F KENNEDY BLVD STE 1404
PHILADELPHIA PA
19103-7417
US

IV. Provider business mailing address

1027 GREGORY LN
TEMPLE PA
19560-9583
US

V. Phone/Fax

Practice location:
  • Phone: 855-675-4010
  • Fax: 617-807-0958
Mailing address:
  • Phone: 917-783-0408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018268
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: