Provider Demographics
NPI:1073520672
Name:MELNICK, LEAONARD (LICSW)
Entity Type:Individual
Prefix:
First Name:LEAONARD
Middle Name:
Last Name:MELNICK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 GRANBY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1969
Mailing Address - Country:US
Mailing Address - Phone:413-523-0900
Mailing Address - Fax:413-523-0901
Practice Address - Street 1:1109 GRANBY RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1568
Practice Address - Country:US
Practice Address - Phone:413-523-0900
Practice Address - Fax:413-523-0901
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105787104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20904Medicare ID - Type Unspecified
MAS59653Medicare UPIN