Healthcare Provider Details

I. General information

NPI: 1992029631
Provider Name (Legal Business Name): MS. MELISSA VLIEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CENTRAL AVE 5 TH FLOOR
ALBANY NY
12206-2937
US

IV. Provider business mailing address

175 CENTRAL AVE 5 TH FLOOR
ALBANY NY
12206-2937
US

V. Phone/Fax

Practice location:
  • Phone: 518-436-4462
  • Fax: 518-436-4558
Mailing address:
  • Phone: 518-436-4462
  • Fax: 518-436-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRO20074-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: