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General NPI Number Information
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NPI Number | 1013673516
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Entity Type | Organization
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Legal Business Name | EMERGENT CHANGE COUNSELING & HEALING
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 18-20 LACKAWANNA PLZ STE 300
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3642
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Country | US
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Telephone | 973-671-4309
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Fax | 973-629-1778
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Provider Business Mailing Address
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Address Line | 125 GLENRIDGE AVE UNIT 289
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City | MONTCLAIR
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State | NJ
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Zip | 07042-6812
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Country | US
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Telephone | 973-671-4309
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Fax | 973-629-1778
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Authorized Official
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Title or Position | OWNER
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Name | LAURA L MELENDEZ
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Credential | LCSW
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Telephone | 862-252-4001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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