Provider Demographics
NPI:1639738552
Name:BREWSTER, MELANIE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:E
Last Name:BREWSTER
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 1:515 MADISON AVE FL 21
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-5433
Mailing Address - Country:US
Mailing Address - Phone:516-701-2138
Mailing Address - Fax:
Practice Address - Street 1:515 MADISON AVE FL 21
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5433
Practice Address - Country:US
Practice Address - Phone:646-389-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022625103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty