Provider Demographics
NPI:1235512153
Name:BERTOTTI, MELINDA
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:BERTOTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WOODHULL ST
Mailing Address - Street 2:APT 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-5104
Mailing Address - Country:US
Mailing Address - Phone:616-307-1315
Mailing Address - Fax:
Practice Address - Street 1:921 FULTON ST
Practice Address - Street 2:APT 3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1710
Practice Address - Country:US
Practice Address - Phone:616-307-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0958541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical