Healthcare Provider Details

I. General information

NPI: 1669703393
Provider Name (Legal Business Name): MELISSA FIRMES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 OAK ST
COPIAGUE NY
11726-3111
US

IV. Provider business mailing address

70 NORTH DR
COPIAGUE NY
11726-5124
US

V. Phone/Fax

Practice location:
  • Phone: 631-691-7080
  • Fax:
Mailing address:
  • Phone: 631-691-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number072166-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: