Provider Demographics
NPI:1265903207
Name:SEYMOUR, MELISSA ANN (LMCH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:LMCH
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MAJOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3603 KEMP DR
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2409
Mailing Address - Country:US
Mailing Address - Phone:607-348-7025
Mailing Address - Fax:
Practice Address - Street 1:650 WARREN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-2998
Practice Address - Country:US
Practice Address - Phone:518-491-6469
Practice Address - Fax:518-462-0181
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health