Provider Demographics
NPI:1306323969
Name:ADOLPHE, MELISSA (MHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ADOLPHE
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 UNION RD APT E26
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3923
Mailing Address - Country:US
Mailing Address - Phone:845-608-5279
Mailing Address - Fax:
Practice Address - Street 1:161 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2030
Practice Address - Country:US
Practice Address - Phone:845-675-7596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health