MEDICARE: MRS. MELISSA FORSYTH

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1508252420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA FORSYTH

Provider Business Mailing Address
First Line	:	240 WOOLLEY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-2002
Country	:	US
Telephone Number	:	917-685-7028
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 WOOLLEY AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-2002
Country	:	US
Telephone Number	:	917-685-7028
Fax Number	:

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

Provider Enumeration Date	:	04/07/2015
Last Update Date	:	04/07/2015

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