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General NPI Number Information
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NPI Number | 1902532567
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Entity Type | Individual
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Provider Name | MELVIN CHILDS
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Gender | Male
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Dates
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Enumeration Date | 07/26/2022
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Last Update Date | 07/26/2022
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Provider Practice Location Address
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Address Line | 18718 LINDEN BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-4026
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Country | US
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Telephone | 347-894-8111
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Fax | 347-894-8128
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Provider Business Mailing Address
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Address Line | 8810 178TH ST APT 3B
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City | JAMAICA
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State | NY
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Zip | 11432-4610
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Country | US
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Telephone | 678-927-4494
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Fax | 347-894-8128
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 056948-1
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License Number State | NY
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