Healthcare Provider Details

I. General information

NPI: 1467102889
Provider Name (Legal Business Name): MELISSA WEISEL PHD LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 3RD AVE APT 4B
NEW YORK NY
10028-1962
US

IV. Provider business mailing address

1438 3RD AVE APT 4B
NEW YORK NY
10028-1962
US

V. Phone/Fax

Practice location:
  • Phone: 201-693-6330
  • Fax:
Mailing address:
  • Phone: 201-693-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA WEISEL
Title or Position: CEO LCSW
Credential: PHD LCSW
Phone: 201-693-6330