Provider Demographics
NPI:1477842359
Name:NIEMAN, MELISSA RENE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENE
Last Name:NIEMAN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 W 34TH ST
Mailing Address - Street 2:PENTHOUSE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:646-567-7736
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:ROOM GC-65
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-7976
Practice Address - Fax:212-562-3382
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0634131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical