Provider Demographics
NPI:1336202001
Name:MELINCOFF, DEBORAH SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUSAN
Last Name:MELINCOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 72ND ST
Mailing Address - Street 2:SUITE 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3204
Mailing Address - Country:US
Mailing Address - Phone:646-207-8276
Mailing Address - Fax:
Practice Address - Street 1:117 W 72ND ST
Practice Address - Street 2:SUITE 5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3204
Practice Address - Country:US
Practice Address - Phone:646-207-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015426103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling