Provider Demographics
NPI:1972920700
Name:KOSCHNITZKE, MELANIE (MSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:KOSCHNITZKE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:103 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3713
Mailing Address - Country:US
Mailing Address - Phone:203-517-3371
Mailing Address - Fax:203-348-9378
Practice Address - Street 1:103 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3713
Practice Address - Country:US
Practice Address - Phone:203-517-3371
Practice Address - Fax:203-348-9378
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical