Provider Demographics
NPI:1871851030
Name:JEWELS, MELLISA ANN (MA)
Entity Type:Individual
Prefix:MS
First Name:MELLISA
Middle Name:ANN
Last Name:JEWELS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GOOSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11724-1308
Mailing Address - Country:US
Mailing Address - Phone:631-692-9689
Mailing Address - Fax:
Practice Address - Street 1:18 GOOSE HILL RD
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-1308
Practice Address - Country:US
Practice Address - Phone:631-692-9689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000946-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist