Provider Demographics
NPI:1326130386
Name:MIDONECK, MELODY (DSW LCSW LLC)
Entity Type:Individual
Prefix:DR
First Name:MELODY
Middle Name:
Last Name:MIDONECK
Suffix:
Gender:F
Credentials:DSW LCSW LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9833 HALSTON MNR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4977
Mailing Address - Country:US
Mailing Address - Phone:732-490-8136
Mailing Address - Fax:
Practice Address - Street 1:9833 HALSTON MNR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4977
Practice Address - Country:US
Practice Address - Phone:732-490-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048369001041C0700X
FLSW154461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical