Provider Demographics
NPI:1215442355
Name:MELENDEZ, LILIANA
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:MELENDEZ
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 1:1143 LONGFELLOW AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2679
Mailing Address - Country:US
Mailing Address - Phone:347-223-0001
Mailing Address - Fax:
Practice Address - Street 1:501 CHESTNUT RIDGE RD STE 205
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-5669
Practice Address - Country:US
Practice Address - Phone:845-738-4362
Practice Address - Fax:845-738-1011
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst