Provider Demographics
NPI:1255978805
Name:HEITZ, MELINDA SUE (LMSW)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:SUE
Last Name:HEITZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:HEITZENRATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 LACKAWANNA AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-1001
Mailing Address - Country:US
Mailing Address - Phone:585-658-7857
Mailing Address - Fax:
Practice Address - Street 1:27 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1001
Practice Address - Country:US
Practice Address - Phone:585-658-7857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1368163191101YS0200X
NY1080581041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool