Individual
DR. MARY ELLEN STANISCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
654 NEWMAN SPRINGS ROAD, LINCROFT, NJ 07738
(732) 671-0196
(732) 936-0404
Mailing address
13 GARRYFORD DRIVE, MIDDLETOWN, NJ 07748
(732) 671-0196
(732) 936-0404
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
SI02401
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1302302
—
NJ
Enumeration date
01/18/2007
Last updated
07/08/2007
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