Provider Demographics
NPI:1992029631
Name:VLIEK, MELISSA
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:VLIEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CENTRAL AVE
Mailing Address - Street 2:5 TH FLOOR
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-2937
Mailing Address - Country:US
Mailing Address - Phone:518-436-4462
Mailing Address - Fax:518-436-4558
Practice Address - Street 1:175 CENTRAL AVE
Practice Address - Street 2:5 TH FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-2937
Practice Address - Country:US
Practice Address - Phone:518-436-4462
Practice Address - Fax:518-436-4558
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO20074-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical