Provider Demographics
NPI:1104330448
Name:FOELLMI, MELODIE (PHD)
Entity type:Individual
Prefix:DR
First Name:MELODIE
Middle Name:
Last Name:FOELLMI
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 1:155 W 9TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3903
Mailing Address - Country:US
Mailing Address - Phone:917-991-4630
Mailing Address - Fax:
Practice Address - Street 1:175 REMSEN ST STE 500
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4300
Practice Address - Country:US
Practice Address - Phone:718-975-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022308103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Single Specialty