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General NPI Number Information
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NPI Number | 1205443066
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Entity Type | Organization
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Legal Business Name | DR. MELITA PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 09/25/2020
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Last Update Date | 09/25/2020
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Provider Practice Location Address
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Address Line | 515 MADISON AVE FL 21
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City | NEW YORK
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State | NY
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Zip | 10022-5433
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Country | US
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Telephone | 917-336-1673
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Fax |
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Provider Business Mailing Address
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Address Line | 555 MADISON AVE FL 5
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City | NEW YORK
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State | NY
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Zip | 10022-3410
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Country | US
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Telephone | 917-336-1673
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MELITA THAIS PSYCHOLOGICAL
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Credential | L,PSYCH PHD
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Telephone | 803-467-9628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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