Provider Demographics
NPI:1861740565
Name:MICELI, FRAN
Entity type:Individual
Prefix:
First Name:FRAN
Middle Name:
Last Name:MICELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3440
Mailing Address - Country:US
Mailing Address - Phone:732-223-4673
Mailing Address - Fax:732-722-7867
Practice Address - Street 1:36 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3440
Practice Address - Country:US
Practice Address - Phone:732-223-4673
Practice Address - Fax:732-722-7867
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00103300101YA0400X
NJ44SW00326600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker