Provider Demographics
NPI:1164675997
Name:ANDERSON, MELINDA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:MARIE
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-431-5475
Mailing Address - Fax:607-431-5477
Practice Address - Street 1:1 ATWELL RD
Practice Address - Street 2:
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326-1301
Practice Address - Country:US
Practice Address - Phone:607-431-5475
Practice Address - Fax:607-431-5477
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07378811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3310Medicare UPIN