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General NPI Number Information
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NPI Number | 1437880820
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Entity Type | Individual
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Provider Name | MELANIE LISA LUCANIE LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 360 MAIN ST # 2D
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3375
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Country | US
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Telephone | 860-248-6046
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Fax | 844-264-0237
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Provider Business Mailing Address
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Address Line | 67 SWAN HOLLOW RD
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City | NEW WINDSOR
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State | NY
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Zip | 12553-4956
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Country | US
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Telephone | 845-709-9183
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 091896
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12266
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License Number State | CT
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