Individual
MELISSA DE GANNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
80 MAIN ST STE 410, WEST ORANGE, NJ 07052-5441
(973) 986-7261
Mailing address
13 HENRY ST APT 8, BLOOMFIELD, NJ 07003-2443
(973) 986-7261
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103TC1900X
Counseling Psychologist
—
—
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
06/08/2024
Last updated
06/27/2024
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