Provider Demographics
NPI:1063880193
Name:FENDRICH, MELISSA ROSE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:FENDRICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1486 CLOVE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-6436
Mailing Address - Country:US
Mailing Address - Phone:845-416-1127
Mailing Address - Fax:
Practice Address - Street 1:13 MOUNT CARMEL PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1714
Practice Address - Country:US
Practice Address - Phone:845-452-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-06
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health