MEDICARE: MELISSA HENAO LPC

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	101YM0800X	Mental Health Counselor	37AC00557700
2	101Y00000X	Counselor	37PC00991100	NJ

General Provider Information

NPI Number	:	1710572144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA HENAO LPC

Provider Business Mailing Address
First Line	:	88 SHALER AVE
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-2013
Country	:	US
Telephone Number	:	201-851-2254
Fax Number	:

Provider Business Practice Location Address
First Line	:	256 WANAQUE AVE
Second Line	:
City	:	POMPTON LAKES
State	:	NJ
Zip	:	07442-2153
Country	:	US
Telephone Number	:	732-955-7436
Fax Number	:

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

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	06/25/2024

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