Provider Demographics
NPI:1467909416
Name:MELODY MONIQUE CLEMONS-SMITH
Entity Type:Organization
Organization Name:MELODY MONIQUE CLEMONS-SMITH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMSW
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:CLEMONS-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:516-439-1929
Mailing Address - Street 1:50 W HAWTHORNE AVE # 3
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6220
Mailing Address - Country:US
Mailing Address - Phone:516-569-6600
Mailing Address - Fax:
Practice Address - Street 1:50 W HAWTHORNE AVE # 3
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6220
Practice Address - Country:US
Practice Address - Phone:516-569-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72098334251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health