Provider Demographics
NPI:1326582131
Name:JARDIN, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:JARDIN
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 1:41 UNION SQ W
Mailing Address - Street 2:SUITE 1328
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3236
Mailing Address - Country:US
Mailing Address - Phone:510-329-8472
Mailing Address - Fax:
Practice Address - Street 1:41 UNION SQ W
Practice Address - Street 2:SUITE 1328
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3236
Practice Address - Country:US
Practice Address - Phone:510-329-8472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist