Provider Demographics
NPI:1912370107
Name:BRAUNSTEIN, MELISSA CARYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:CARYN
Last Name:BRAUNSTEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24302 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1150
Mailing Address - Country:US
Mailing Address - Phone:718-423-6200
Mailing Address - Fax:
Practice Address - Street 1:24302 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1150
Practice Address - Country:US
Practice Address - Phone:718-423-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP99809390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program