Provider Demographics
NPI:1972868297
Name:BOKSER, MELISSA IRIS (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:IRIS
Last Name:BOKSER
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 RADCLIFFE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5208
Mailing Address - Country:US
Mailing Address - Phone:516-313-7093
Mailing Address - Fax:516-777-3844
Practice Address - Street 1:219 RADCLIFFE AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-5208
Practice Address - Country:US
Practice Address - Phone:516-313-7093
Practice Address - Fax:516-777-3844
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0704181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400098348Medicare PIN