Provider Demographics
NPI:1205821006
Name:COREN, MELISSA F (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:F
Last Name:COREN
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 1:884 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3514
Mailing Address - Country:US
Mailing Address - Phone:212-663-8339
Mailing Address - Fax:212-663-8733
Practice Address - Street 1:884 W END AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3514
Practice Address - Country:US
Practice Address - Phone:212-663-8339
Practice Address - Fax:212-663-8733
Is Sole Proprietor?:No
Enumeration Date:2005-09-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR040195-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN57331Medicare ID - Type UnspecifiedMEDICARE PROVIDER