Healthcare Provider Details

I. General information

NPI: 1932713427
Provider Name (Legal Business Name): MELANIE RACHEL BTESH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 LIVINGSTON ST
BROOKLYN NY
11217-1006
US

IV. Provider business mailing address

569 AVENUE Y
BROOKLYN NY
11235-6101
US

V. Phone/Fax

Practice location:
  • Phone: 718-935-9201
  • Fax:
Mailing address:
  • Phone: 347-662-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014703-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: