Provider Demographics
NPI:1285882894
Name:MILLANDO-WIRTENSON, MELODY (PHD)
Entity type:Individual
Prefix:DR
First Name:MELODY
Middle Name:
Last Name:MILLANDO-WIRTENSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:MILLANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:79 MIDDLEVILLE RD
Mailing Address - Street 2:NORTHPORT VAMC PSYCHOLOGY SERVICE (116B)
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2200
Mailing Address - Country:US
Mailing Address - Phone:631-261-4400
Mailing Address - Fax:631-266-6086
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:NORTHPORT VAMC PSYCHOLOGY SERVICE (116B)
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-266-6086
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-017770103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical