Provider Demographics
NPI:1215693262
Name:GUTTMAN, MELISSA KERRY (MT-BC, LCAT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KERRY
Last Name:GUTTMAN
Suffix:
Gender:F
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S 5TH ST OFC EAST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5597
Mailing Address - Country:US
Mailing Address - Phone:973-604-8815
Mailing Address - Fax:
Practice Address - Street 1:141 S 5TH ST OFC EAST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5597
Practice Address - Country:US
Practice Address - Phone:973-713-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225A00000X
NY100512-02225A00000X
NY002726225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist