Healthcare Provider Details

I. General information

NPI: 1013843226
Provider Name (Legal Business Name): BRITNEY MELENDA MOODY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 HALPERIN AVE
BRONX NY
10461-2631
US

IV. Provider business mailing address

630 E LINCOLN AVE
MOUNT VERNON NY
10552-3825
US

V. Phone/Fax

Practice location:
  • Phone: 718-638-7682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: