Provider Demographics
NPI:1649574039
Name:TAMAYO, MELIDA IVONNE (LMSW)
Entity type:Individual
Prefix:
First Name:MELIDA
Middle Name:IVONNE
Last Name:TAMAYO
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 1:14113 UNION TPKE
Mailing Address - Street 2:3N
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3682
Mailing Address - Country:US
Mailing Address - Phone:718-443-9300
Mailing Address - Fax:718-919-6153
Practice Address - Street 1:335 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-4501
Practice Address - Country:US
Practice Address - Phone:718-443-9300
Practice Address - Fax:718-919-6153
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0829801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical