Provider Demographics
NPI:1215373998
Name:MELNICK, JENNIFER B (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:MELNICK
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:B
Other - Last Name:MENSCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2174 HEWLETT AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3606
Mailing Address - Country:US
Mailing Address - Phone:718-490-6705
Mailing Address - Fax:
Practice Address - Street 1:2174 HEWLETT AVE
Practice Address - Street 2:STE 220
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3606
Practice Address - Country:US
Practice Address - Phone:718-490-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0716251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03753660Medicaid