Provider Demographics
NPI:1053687442
Name:ORTEGA, MELISSA LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:LEE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
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Mailing Address - Street 1:445 PARK AVENUE
Mailing Address - Street 2:CHILD MIND INSTITUTE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:646-625-4360
Mailing Address - Fax:646-625-4352
Practice Address - Street 1:445 PARK AVE
Practice Address - Street 2:CHILD MIND INSTITUTE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2606
Practice Address - Country:US
Practice Address - Phone:646-625-4360
Practice Address - Fax:646-625-4352
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY019466103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical