Provider Demographics
NPI:1730670860
Name:KALLFELZ, MELISSA MARY (LMHC LIMITED PERMIT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARY
Last Name:KALLFELZ
Suffix:
Gender:F
Credentials:LMHC LIMITED PERMIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 FENNELL ST
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-1117
Mailing Address - Country:US
Mailing Address - Phone:315-345-7257
Mailing Address - Fax:
Practice Address - Street 1:29 FENNELL ST
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-1117
Practice Address - Country:US
Practice Address - Phone:315-345-7257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP99881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health