Provider Demographics
NPI:1114465077
Name:THOMAS, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470A GLEBE AVE
Mailing Address - Street 2:B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3154
Mailing Address - Country:US
Mailing Address - Phone:646-384-4590
Mailing Address - Fax:
Practice Address - Street 1:1600 MACOMBS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-2016
Practice Address - Country:US
Practice Address - Phone:718-299-3300
Practice Address - Fax:718-299-5905
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)