Provider Demographics
NPI:1760530877
Name:PEARSON, MELINDA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ROGERS RD
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538-2935
Mailing Address - Country:US
Mailing Address - Phone:914-204-1597
Mailing Address - Fax:845-698-0155
Practice Address - Street 1:49 ROGERS RD
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538-2935
Practice Address - Country:US
Practice Address - Phone:914-204-1597
Practice Address - Fax:845-698-0155
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02753102Medicaid