Provider Demographics
NPI:1770654162
Name:LICHTENSTEIN, MELVIN (MSW)
Entity Type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:LICHTENSTEIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 E 77 STREET
Mailing Address - Street 2:APT 58
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1944
Mailing Address - Country:US
Mailing Address - Phone:212-734-8610
Mailing Address - Fax:
Practice Address - Street 1:155 E 77 STREET
Practice Address - Street 2:APT 58
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1944
Practice Address - Country:US
Practice Address - Phone:212-734-8610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWPR01554611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P734162OtherOXFORD HEALTH PLANS
N98461Medicare ID - Type Unspecified