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Individual

MR. MARK MELILLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MS, LCADC, RYT-200

Contact information

Practice address
1 MONUMENT DRIVE, PRINCETON, NJ 08540-4014
(609) 924-8018
(609) 688-2045
Mailing address
5 LINCOLN PL, D, NORTH BRUNSWICK, NJ 08902-4014
(732) 331-7796

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
37LC00252200
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1174978159
NJ
Enumeration date
04/27/2016
Last updated
01/13/2017
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