Provider Demographics
NPI:1851461784
Name:MELZAK, BENNETT
Entity Type:Individual
Prefix:MR
First Name:BENNETT
Middle Name:
Last Name:MELZAK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BENNETT
Other - Middle Name:
Other - Last Name:MELZAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, PSYCHOANALYST
Mailing Address - Street 1:4761 BROADWAY APT 4Z
Mailing Address - Street 2:OFFICE- 41-51 EAST 11TH ST.-4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-4938
Mailing Address - Country:US
Mailing Address - Phone:212-942-7670
Mailing Address - Fax:
Practice Address - Street 1:41-51 EAST 11TH STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:917-579-5507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO37000-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical