Provider Demographics
NPI:1417058454
Name:MELON, YANDIRA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:YANDIRA
Middle Name:
Last Name:MELON
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:PO BOX 1908
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-1908
Mailing Address - Country:US
Mailing Address - Phone:914-980-6509
Mailing Address - Fax:845-354-0026
Practice Address - Street 1:6 SMITH ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2913
Practice Address - Country:US
Practice Address - Phone:914-980-6509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02133211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical