Provider Demographics
NPI:1316587017
Name:MAHON, MELODY (RESIDENTIAL COUSELOR)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:MAHON
Suffix:
Gender:F
Credentials:RESIDENTIAL COUSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MELODY MAHON COUNSELOR
Mailing Address - Street 2:2415 WESTCHESTER AVENUE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:718-863-4100
Mailing Address - Fax:718-863-5165
Practice Address - Street 1:2415 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3538
Practice Address - Country:US
Practice Address - Phone:718-863-4100
Practice Address - Fax:718-863-5165
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health