Provider Demographics
NPI:1740590702
Name:JANKOVIC, MELISSA ANN (MS, CAS)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:JANKOVIC
Suffix:
Gender:F
Credentials:MS, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 STATE ST
Mailing Address - Street 2:ROOM 300
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2005
Mailing Address - Country:US
Mailing Address - Phone:518-447-4920
Mailing Address - Fax:518-447-4855
Practice Address - Street 1:112 STATE ST
Practice Address - Street 2:ROOM 300
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-2005
Practice Address - Country:US
Practice Address - Phone:518-447-4920
Practice Address - Fax:518-447-4855
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool