Provider Demographics
NPI:1194824292
Name:GIUTTARI, MELISSA R (LCMHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:GIUTTARI
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 PAVONIA AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-1712
Mailing Address - Country:US
Mailing Address - Phone:718-213-8664
Mailing Address - Fax:
Practice Address - Street 1:26 WEST 9TH STREET
Practice Address - Street 2:SUITE 2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:718-213-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004803-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00059819OtherBC/BS OF VT
VT1010318Medicaid
VT360278OtherTRICARE