Healthcare Provider Details

I. General information

NPI: 1265987929
Provider Name (Legal Business Name): MELISSA M SCHROEDER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W MAIN ST
PATCHOGUE NY
11772-3012
US

IV. Provider business mailing address

PO BOX 211
ISLIP NY
11751-0211
US

V. Phone/Fax

Practice location:
  • Phone: 631-268-4148
  • Fax:
Mailing address:
  • Phone: 631-514-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number022463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-17594
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: