Individual
ELYSSA MARTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
96 CHADWICK ST, EAST RUTHERFORD, NJ 07073-1603
(201) 414-1568
Mailing address
96 CHADWICK ST, EAST RUTHERFORD, NJ 07073-1603
(201) 414-1568
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BACB765732
NJ
Other
Enumeration date
12/11/2024
Last updated
12/11/2024
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