Provider Demographics
NPI:1548426331
Name:MELENDEZ, LENA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LENA
Middle Name:ANN
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:ANN
Other - Last Name:MELENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:565 W 162ND ST APT 63
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-5932
Mailing Address - Country:US
Mailing Address - Phone:347-806-1105
Mailing Address - Fax:
Practice Address - Street 1:565 W 162ND ST APT 63
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5932
Practice Address - Country:US
Practice Address - Phone:347-806-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0793831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY584984911OtherNYS DRIVER LICENSE