Provider Demographics
NPI:1306637178
Name:WAUGH, MELODY L (LMSW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:L
Last Name:WAUGH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 DUKE OF GLOUCESTER WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:14425-9631
Mailing Address - Country:US
Mailing Address - Phone:585-957-1525
Mailing Address - Fax:
Practice Address - Street 1:5760 DUKE OF GLOUCESTER WAY
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NY
Practice Address - Zip Code:14425-9631
Practice Address - Country:US
Practice Address - Phone:585-957-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110969104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker