Provider Demographics
NPI:1174090211
Name:SCHWANER, MELISSA C (MSW, LCSW)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:C
Last Name:SCHWANER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 RALEIGH DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5610
Mailing Address - Country:US
Mailing Address - Phone:732-597-8492
Mailing Address - Fax:
Practice Address - Street 1:252 WASHINGTON ST # B2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7582
Practice Address - Country:US
Practice Address - Phone:732-966-4166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058186001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0029807Medicaid