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NPI Code Detail

MEDICARE: MELINDA LISNY LCSW,LCADC

MEDICARE: MELINDA LISNY LCSW,LCADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor37LC00082500NJ
21041C0700XClinical Social Worker44SC05265900NJ

General Provider Information

NPI Number : 1114076668
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA LISNY LCSW,LCADC
Provider Business Mailing Address
First Line : 114 MOUNT TABOR WAY
Second Line :
City : OCEAN GROVE
State : NJ
Zip : 07756-1414
Country : US
Telephone Number : 732-774-0014
Fax Number :
Provider Business Practice Location Address
First Line : 166 MAIN ST
Second Line :
City : MATAWAN
State : NJ
Zip : 07747-3104
Country : US
Telephone Number : 732-290-9040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 09/11/2025

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