Provider Demographics
NPI:1144758608
Name:GORENFLO GILBERT, MELANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:GORENFLO GILBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:NY
Mailing Address - Zip Code:10548-0031
Mailing Address - Country:US
Mailing Address - Phone:914-671-5962
Mailing Address - Fax:
Practice Address - Street 1:22 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548-1012
Practice Address - Country:US
Practice Address - Phone:914-671-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist