Provider Demographics
NPI:1295579191
Name:MELENDEZ, AMY IVONNE (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:IVONNE
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3059 SATSUMA DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-3747
Mailing Address - Country:US
Mailing Address - Phone:214-404-1759
Mailing Address - Fax:
Practice Address - Street 1:5750 PINELAND DR STE 260
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5300
Practice Address - Country:US
Practice Address - Phone:214-221-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113465104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker