Provider Demographics
NPI:1598210221
Name:DACKIS, MELISSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:DACKIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W 88TH ST
Mailing Address - Street 2:APT 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2537
Mailing Address - Country:US
Mailing Address - Phone:908-930-0412
Mailing Address - Fax:
Practice Address - Street 1:3340 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2802
Practice Address - Country:US
Practice Address - Phone:718-696-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical