Provider Demographics
NPI:1639588304
Name:JAUSS, MELISSA ANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:JAUSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 81ST ST
Mailing Address - Street 2:#3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-7230
Mailing Address - Country:US
Mailing Address - Phone:646-642-7533
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:212-633-9162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 088235104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker