Healthcare Provider Details

I. General information

NPI: 1649574039
Provider Name (Legal Business Name): MELIDA IVONNE TAMAYO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 CENTRAL AVE
BROOKLYN NY
11221-4501
US

IV. Provider business mailing address

14113 UNION TPKE 3N
FLUSHING NY
11367-3682
US

V. Phone/Fax

Practice location:
  • Phone: 718-443-9300
  • Fax: 718-919-6153
Mailing address:
  • Phone: 718-443-9300
  • Fax: 718-919-6153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: