Active NPI
Melissa Green-Jackson, LPC
- Professional Counselor
- Midland Park, NJ
National Provider Identifier
1013563576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 37PC00400000
- Practice address
- 317 Godwin Ave
Midland Park, NJ 07432-1519 - Phone
- (201) 241-2422
- NPI assigned
- Aug 12, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 37PC00400000 | NJ | Primary |
Addresses
Primary practice location
317 Godwin Ave
Midland Park, NJ 07432-1519
Mailing address
159 Vreeland Ave
Rutherford, NJ 07070-2229
Phone (201) 615-0204
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37PC00400000 | NJ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1565568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1565568000000",
"number": "1013563576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 VREELAND AVE",
"city": "RUTHERFORD",
"state": "NJ",
"postal_code": "070702229",
"telephone_number": "201-615-0204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "317 GODWIN AVE",
"city": "MIDLAND PARK",
"state": "NJ",
"postal_code": "074321519",
"telephone_number": "201-241-2422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN-JACKSON",
"first_name": "MELISSA",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-12",
"last_updated": "2019-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37PC00400000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midland Park, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.