MEDICARE: MELISSA THOEN LCSW

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	1041C0700X	Clinical Social Worker	088284	NY

General Provider Information

NPI Number	:	1124476247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA THOEN LCSW

Provider Business Mailing Address
First Line	:	936 BROADWAY
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10010-6013
Country	:	US
Telephone Number	:	212-879-4900
Fax Number	:	212-774-0206

Provider Business Practice Location Address
First Line	:	936 BROADWAY FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-8104
Country	:	US
Telephone Number	:	212-879-4900
Fax Number	:	212-774-0206

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

Provider Enumeration Date	:	05/31/2016
Last Update Date	:	02/02/2021

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