Provider Demographics
NPI:1982067492
Name:MANN, MELECH DAVID (MSW LISW EMDR)
Entity Type:Individual
Prefix:MR
First Name:MELECH
Middle Name:DAVID
Last Name:MANN
Suffix:
Gender:M
Credentials:MSW LISW EMDR
Other - Prefix:
Other - First Name:MELECH
Other - Middle Name:D
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW LISW EMDR
Mailing Address - Street 1:1032 BAY 24TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1802
Mailing Address - Country:US
Mailing Address - Phone:929-278-0537
Mailing Address - Fax:
Practice Address - Street 1:1032 BAY 24TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1802
Practice Address - Country:US
Practice Address - Phone:929-278-0537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18009341041C0700X
NY0954431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY095443OtherNEW YORK STATE BOARD OF CERTIFIED SOCIAL WORKERS
OHI.1800934OtherNATIONAL ASSOCIATION OF SOCIAL WORK (NASW)