Provider Demographics
NPI:1003402934
Name:PODSIADLO, MELANIE F (PSYD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:F
Last Name:PODSIADLO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STONE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01230-9744
Mailing Address - Country:US
Mailing Address - Phone:413-229-3333
Mailing Address - Fax:855-701-1083
Practice Address - Street 1:100 STONE MANOR DR
Practice Address - Street 2:
Practice Address - City:NEW MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01230-9744
Practice Address - Country:US
Practice Address - Phone:413-229-3333
Practice Address - Fax:855-701-1083
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017171103TC0700X
MA11247103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical