MEDICARE: JOHN DAVID MELENDEZ LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0	NY
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1093241291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID MELENDEZ LMHC

Provider Business Mailing Address
First Line	:	1630 E 15TH ST FL 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1193
Country	:	US
Telephone Number	:	347-563-1370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 E 15TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1192
Country	:	US
Telephone Number	:	347-563-1370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2017
Last Update Date	:	12/20/2023

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