Provider Demographics
NPI:1437270170
Name:ATKINSON, MELISSA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:B
Last Name:ATKINSON
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 1:436 WILLIS AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596
Mailing Address - Country:US
Mailing Address - Phone:516-294-3837
Mailing Address - Fax:516-801-3573
Practice Address - Street 1:436 WILLIS AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596
Practice Address - Country:US
Practice Address - Phone:516-294-3837
Practice Address - Fax:516-801-3573
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRCSW022176-1104100000X
104100000X
NYRCSW022176104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker