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General NPI Number Information
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NPI Number | 1114368180
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Entity Type | Individual
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Provider Name | INGRID MELLOR LCAT
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 29 W 36TH ST STE 5E
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City | NEW YORK
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State | NY
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Zip | 10018-7907
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Country | US
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Telephone | 908-240-1462
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Fax |
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Provider Business Mailing Address
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Address Line | 486 PUTNAM AVE APT 2
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City | BROOKLYN
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State | NY
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Zip | 11221-1003
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Country | US
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Telephone | 908-240-1462
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 002051
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License Number State | NY
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