Provider Demographics
NPI:1245619980
Name:ROBERTS, MELINA L
Entity Type:Individual
Prefix:MS
First Name:MELINA
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:441 BROOKLYN AVE
Mailing Address - Street 2:1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3249
Mailing Address - Country:US
Mailing Address - Phone:347-403-8584
Mailing Address - Fax:718-693-9218
Practice Address - Street 1:441 BROOKLYN AVE
Practice Address - Street 2:1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3249
Practice Address - Country:US
Practice Address - Phone:347-403-8584
Practice Address - Fax:718-693-9218
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21418101YA0400X
NY083593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)