Provider Demographics
NPI:1285283945
Name:COMPTON, MELISSA
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:COMPTON
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 1:216 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3509
Mailing Address - Country:US
Mailing Address - Phone:410-422-1443
Mailing Address - Fax:
Practice Address - Street 1:3455 ERIEVILLE RD
Practice Address - Street 2:
Practice Address - City:ERIEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13061-3176
Practice Address - Country:US
Practice Address - Phone:315-288-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
FLTPMC2993101YM0800X
NY002800221700000X
NY013203101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program