Provider Demographics
NPI:1477859510
Name:MELENDY, KEVIN D (LCSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:MELENDY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 CLARK ST FL 2
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-3205
Mailing Address - Country:US
Mailing Address - Phone:201-925-7950
Mailing Address - Fax:
Practice Address - Street 1:157 ENGLE ST STE 2
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2508
Practice Address - Country:US
Practice Address - Phone:201-987-5988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056259001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical