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General NPI Number Information
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NPI Number | 1629069711
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Entity Type | Individual
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Provider Name | MARK V. MELLINGER PHD
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Gender | Male
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Dates
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Enumeration Date | 10/29/2005
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 680 W END AVE SUITE 1A
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City | NEW YORK
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State | NY
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Zip | 10025-6815
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Country | US
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Telephone | 212-864-2436
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 WARBURTON AVENUE APT. 9T
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City | YONKERS
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State | NY
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Zip | 10701-1018
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Country | US
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Telephone | 914-613-4840
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 006704-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002093
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License Number State | CT
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