=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881928018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELINDA BARDOS LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2009
-----------------------------------------------------
Last Update Date | 03/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44 E 32ND ST 11TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-5508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-484-1715
-----------------------------------------------------
Fax | 646-484-1715
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 WASHINGTON SQUARE VLG 9J
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10012-1732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-903-4656
-----------------------------------------------------
Fax | 917-903-4656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 078469
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------