Provider Demographics
NPI:1740589639
Name:MCINTOSH, MELISSA KATE (MPS, ATR-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KATE
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MPS, ATR-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 W. 21ST ST., #3SC
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3200
Mailing Address - Country:US
Mailing Address - Phone:646-236-3349
Mailing Address - Fax:
Practice Address - Street 1:167 W. 21ST ST., 3SE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3200
Practice Address - Country:US
Practice Address - Phone:646-236-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05001587101YM0800X
IL180007752101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional