Provider Demographics
NPI:1821359076
Name:STASIK, MELODY (LMHC)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:STASIK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1707
Mailing Address - Country:US
Mailing Address - Phone:518-346-0762
Mailing Address - Fax:518-346-0783
Practice Address - Street 1:101 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1707
Practice Address - Country:US
Practice Address - Phone:518-346-0762
Practice Address - Fax:518-346-0783
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005154-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health