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NPI Code Detail

MEDICARE: MS. HEATHER J MANELLO LPC, LCADC

MEDICARE: MS. HEATHER J MANELLO LPC, 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
1101Y00000XCounselor37PC00362400NJ
2101YA0400XAddiction (Substance Use Disorder) Counselor37LC00148300NJ
3101YM0800XMental Health Counselor37PC00362400NJ
4101YP2500XProfessional Counselor37PC00362400NJ

General Provider Information

NPI Number : 1265773683
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. HEATHER J MANELLO LPC, LCADC
Provider Business Mailing Address
First Line : 123 HOW LN
Second Line : THE CENTER FOR GREAT EXPECTATIONS
City : NEW BRUNSWICK
State : NJ
Zip : 08901-3653
Country : US
Telephone Number : 732-993-9762
Fax Number : 732-626-4544
Provider Business Practice Location Address
First Line : 123 HOW LN
Second Line : THE CENTER FOR GREAT EXPECTATIONS
City : NEW BRUNSWICK
State : NJ
Zip : 08901-3653
Country : US
Telephone Number : 732-993-9762
Fax Number : 732-626-4544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2013
Last Update Date : 10/10/2019

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