Provider Demographics
NPI:1164192746
Name:MELINDA NEMIROFF PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:MELINDA NEMIROFF PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:NEMIROFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-693-8705
Mailing Address - Street 1:5837 WOOD STORK WAY
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-0275
Mailing Address - Country:US
Mailing Address - Phone:561-693-8705
Mailing Address - Fax:561-771-9820
Practice Address - Street 1:5837 WOOD STORK WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-0275
Practice Address - Country:US
Practice Address - Phone:561-693-8705
Practice Address - Fax:561-771-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health