Healthcare Provider Details

I. General information

NPI: 1801581889
Provider Name (Legal Business Name): MELANIE DESSOMMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 9TH STREET 2ND FLOOR
BROOKLYN NY
11215-7547
US

IV. Provider business mailing address

90 3RD PL
BROOKLYN NY
11231-4006
US

V. Phone/Fax

Practice location:
  • Phone: 718-483-4913
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number117920-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number117920-01
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117920-01
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number117920-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: