Provider Demographics
NPI:1689710089
Name:MELORE, DANIEL (LCSWR)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:MELORE
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 102ND ST
Mailing Address - Street 2:APT 2U
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2414
Mailing Address - Country:US
Mailing Address - Phone:347-869-4226
Mailing Address - Fax:
Practice Address - Street 1:21015 UNION TPKE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3239
Practice Address - Country:US
Practice Address - Phone:718-224-2646
Practice Address - Fax:718-830-9088
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2016-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02864511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2197706OtherOXFORD