Provider Demographics
NPI:1275934648
Name:SMITH, MELANIE (LMHC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1721
Mailing Address - Country:US
Mailing Address - Phone:315-592-4453
Mailing Address - Fax:315-598-7158
Practice Address - Street 1:163 S 1ST ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1721
Practice Address - Country:US
Practice Address - Phone:315-592-4453
Practice Address - Fax:315-598-7158
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health