Healthcare Provider Details

I. General information

NPI: 1164192746
Provider Name (Legal Business Name): MELINDA NEMIROFF PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 WOOD STORK WAY
THE VILLAGES FL
32163-0275
US

IV. Provider business mailing address

5837 WOOD STORK WAY
THE VILLAGES FL
32163-0275
US

V. Phone/Fax

Practice location:
  • Phone: 561-693-8705
  • Fax: 561-771-9820
Mailing address:
  • Phone: 561-693-8705
  • Fax: 561-771-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELINDA ROBIN NEMIROFF
Title or Position: OWNER
Credential: LCSW
Phone: 561-693-8705