Provider Demographics
NPI:1811436611
Name:KRAHULA, MELODIE (PSYD)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:KRAHULA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COMPUTER DR W
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1614
Mailing Address - Country:US
Mailing Address - Phone:518-626-5137
Mailing Address - Fax:518-458-8613
Practice Address - Street 1:17 COMPUTER DR W
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1614
Practice Address - Country:US
Practice Address - Phone:518-626-5137
Practice Address - Fax:518-458-8613
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021876103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist