| Doctor Name: | MELINDA LISNY |
| NPI Number: | 1114076668 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW,LCADC |
| License Number: | 37LC00082500 |
| Business Practice Address: | 166 Main St Matawan, NJ - 077473104 |
| Business Phone Number: | 7322909040 |
| Business Fax Number: | |
| Mailing Address: | 114 Mount Tabor Way, OCEAN GROVE |
| State: | NJ |
| Postal Code: | 077561414 |
| Phone Number: | 7327740014 |
| Fax Number: | |
| NPI Enumeration Date: | 01/10/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00082500 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |