Provider Demographics
NPI:1598826604
Name:FULGIERI, MELISSA DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:DAWN
Last Name:FULGIERI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2086 WALTOFFER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1533
Mailing Address - Country:US
Mailing Address - Phone:718-918-6176
Mailing Address - Fax:718-918-6160
Practice Address - Street 1:1400 PELHAM PARKWAY SOUTH
Practice Address - Street 2:BUILDING 4 NR-8S2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-918-6176
Practice Address - Fax:718-918-6160
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014940103TA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical