Provider Demographics
NPI:1407906092
Name:SCHROEDER, MELINDA LUCY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:LUCY
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PERRY ST
Mailing Address - Street 2:#2C
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2713
Mailing Address - Country:US
Mailing Address - Phone:212-366-9482
Mailing Address - Fax:
Practice Address - Street 1:9 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10014
Practice Address - Country:US
Practice Address - Phone:212-627-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR02348711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
146556Medicare UPIN
N33581Medicare ID - Type Unspecified