Provider Demographics
NPI:1639313232
Name:LERNER, MELISSA JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:LERNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596
Mailing Address - Country:US
Mailing Address - Phone:516-741-3608
Mailing Address - Fax:
Practice Address - Street 1:195 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596
Practice Address - Country:US
Practice Address - Phone:516-741-3608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLR028483-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
W5X721Medicare PIN