Provider Demographics
NPI:1770645178
Name:MELNICK, KAREN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:MELNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WILL CURL HWY
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-4501
Mailing Address - Country:US
Mailing Address - Phone:631-324-0714
Mailing Address - Fax:631-324-9934
Practice Address - Street 1:12 WILL CURL HWY
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-4501
Practice Address - Country:US
Practice Address - Phone:631-324-0714
Practice Address - Fax:631-324-9934
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033507101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health