Provider Demographics
NPI:1396396776
Name:HALL, MARY MELYSSA (LCAT, MT-BC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MELYSSA
Last Name:HALL
Suffix:
Gender:F
Credentials:LCAT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 FORT WASHINGTON AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4655
Mailing Address - Country:US
Mailing Address - Phone:646-317-5742
Mailing Address - Fax:
Practice Address - Street 1:99 FORT WASHINGTON AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4655
Practice Address - Country:US
Practice Address - Phone:646-317-5742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001985225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist