MEDICARE: MELISSA MUTTER

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
1	1041C0700X	Clinical Social Worker	44SC05824000	NJ

General Provider Information

NPI Number	:	1114494598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MUTTER

Provider Business Mailing Address
First Line	:	PO BOX 834
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08754-0834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 FISCHER BLVD STE 3
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-3818
Country	:	US
Telephone Number	:	732-201-2145
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2018
Last Update Date	:	06/30/2023

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Directions to “ MELISSA MUTTER ” Practice Location

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