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General NPI Number Information
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NPI Number | 1043780398
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Entity Type | Organization
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Legal Business Name | DR. MELODY MIDONECK, DSW, LCSW, LLC
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Dates
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Enumeration Date | 11/29/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 9833 HALSTON MNR
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City | BOYNTON BEACH
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State | FL
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Zip | 33473-4977
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Country | US
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Telephone | 732-490-8136
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Fax |
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Provider Business Mailing Address
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Address Line | 9833 HALSTON MNR
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City | BOYNTON BEACH
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State | FL
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Zip | 33473-4977
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Country | US
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Telephone | 732-490-8136
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DR. MELODY MIDONECK
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Credential | DSW, LCSW
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Telephone | 732-490-8136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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