Provider Demographics
NPI:1386194561
Name:MELENDEZ, REBECCA (5688 (CASAC-G))
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:5688 (CASAC-G)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:VERBANK
Mailing Address - State:NY
Mailing Address - Zip Code:12585-5110
Mailing Address - Country:US
Mailing Address - Phone:914-423-4466
Mailing Address - Fax:914-423-4346
Practice Address - Street 1:23 N CLOVE RD
Practice Address - Street 2:
Practice Address - City:VERBANK
Practice Address - State:NY
Practice Address - Zip Code:12585-5110
Practice Address - Country:US
Practice Address - Phone:914-423-4466
Practice Address - Fax:914-423-4346
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5688101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)