Provider Demographics
NPI:1992014591
Name:BURGARD, MELINDA MARKS (MA, LCAT,CMT)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:MARKS
Last Name:BURGARD
Suffix:
Gender:F
Credentials:MA, LCAT,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10925-0245
Mailing Address - Country:US
Mailing Address - Phone:845-477-0451
Mailing Address - Fax:
Practice Address - Street 1:16 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1027
Practice Address - Country:US
Practice Address - Phone:845-477-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000466225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist