Individual
AMELO BACCHUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
67 SANFORD ST, EAST ORANGE, NJ 07018-1926
(973) 673-3342
(973) 673-5612
Mailing address
54 POLK ST APT O3, NEWARK, NJ 07105-2880
(862) 218-7755
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
37AC00826000
NJ
Other
Enumeration date
10/12/2024
Last updated
10/12/2024
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