Provider Demographics
NPI:1033373550
Name:ALLEN, MELISSA LYNN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LYNN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12411-5004
Mailing Address - Country:US
Mailing Address - Phone:845-594-1418
Mailing Address - Fax:845-728-0667
Practice Address - Street 1:18 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:NY
Practice Address - Zip Code:12411-5004
Practice Address - Country:US
Practice Address - Phone:845-255-4143
Practice Address - Fax:845-382-6004
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR072100-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33988OtherWELLCARE/HARMONY