Provider Demographics
NPI:1124117403
Name:GOODEMOTE, MELISSA S (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:S
Last Name:GOODEMOTE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423A NEW KARNER RD.
Mailing Address - Street 2:UPPER LEVEL
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1840
Mailing Address - Country:US
Mailing Address - Phone:518-275-8672
Mailing Address - Fax:
Practice Address - Street 1:423A NEW KARNER RD.
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1840
Practice Address - Country:US
Practice Address - Phone:518-275-8672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY400989363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health