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General NPI Number Information
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NPI Number | 1326472903
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Entity Type | Organization
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Legal Business Name | MELAND-LEWIS PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 08/30/2013
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 22 NORTH RD
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City | BLOOMINGBURG
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State | NY
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Zip | 12721-4687
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Country | US
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Telephone | 845-978-2758
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Fax |
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Provider Business Mailing Address
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Address Line | 32 SCHREMPP LN
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City | PINE BUSH
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State | NY
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Zip | 12566-5735
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Country | US
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Telephone | 845-978-2758
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. KELLI ANN MELAND-LEWIS
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Credential | PHD
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Telephone | 845-978-2758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 017814
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License Number State | NY
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