Provider Demographics
NPI:1205443066
Name:DR. MELITA PSYCHOLOGICAL SERVICES, PLLC
Entity type:Organization
Organization Name:DR. MELITA PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELITA
Authorized Official - Middle Name:THAIS
Authorized Official - Last Name:PSYCHOLOGICAL
Authorized Official - Suffix:
Authorized Official - Credentials:L,PSYCH PHD
Authorized Official - Phone:803-467-9628
Mailing Address - Street 1:555 MADISON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3410
Mailing Address - Country:US
Mailing Address - Phone:917-336-1673
Mailing Address - Fax:
Practice Address - Street 1:515 MADISON AVE FL 21
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5433
Practice Address - Country:US
Practice Address - Phone:917-336-1673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health