Provider Demographics
NPI:1083617542
Name:PARKER, MELODIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BURD ST
Mailing Address - Street 2:STE 201
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-3226
Mailing Address - Country:US
Mailing Address - Phone:845-353-9333
Mailing Address - Fax:
Practice Address - Street 1:48 BURD ST
Practice Address - Street 2:STE 201
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-3226
Practice Address - Country:US
Practice Address - Phone:845-353-9333
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC008391001041C0700X
NYRO273501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0032774OtherVALUEOPTIONS, EMPIREPLAN
NY9447265OtherOXFORD