Provider Demographics
NPI:1508137472
Name:DELAZAR, MELINDA E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:E
Last Name:DELAZAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MELINDA
Other - Middle Name:E
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:MID-HUDSON FORENSIC PSYCHIATRIC CENTER
Mailing Address - Street 2:2834 ROUTE 17-M
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958
Mailing Address - Country:US
Mailing Address - Phone:845-374-8700
Mailing Address - Fax:
Practice Address - Street 1:410 GIDNEY AVE STOP 3
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3764
Practice Address - Country:US
Practice Address - Phone:845-243-0190
Practice Address - Fax:845-565-5374
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019455-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03498006Medicaid
NY03498006Medicaid