Provider Demographics
NPI:1043780398
Name:DR. MELODY MIDONECK, DSW, LCSW, LLC
Entity Type:Organization
Organization Name:DR. MELODY MIDONECK, DSW, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDONECK
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW
Authorized Official - Phone:732-490-8136
Mailing Address - Street 1:9833 HALSTON MNR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4977
Mailing Address - Country:US
Mailing Address - Phone:732-490-8136
Mailing Address - Fax:
Practice Address - Street 1:9833 HALSTON MNR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4977
Practice Address - Country:US
Practice Address - Phone:732-490-8136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty