Healthcare Provider Details

I. General information

NPI: 1043721269
Provider Name (Legal Business Name): MELANIE VILLANUEVA SAUER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2017
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S ALBANY ST
ITHACA NY
14850-5434
US

IV. Provider business mailing address

109 S ALBANY ST
ITHACA NY
14850-5434
US

V. Phone/Fax

Practice location:
  • Phone: 607-398-0812
  • Fax:
Mailing address:
  • Phone: 607-398-0812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: