Provider Demographics
NPI:1346011350
Name:VOGT, MELISSA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BROOKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-2219
Mailing Address - Country:US
Mailing Address - Phone:631-294-1749
Mailing Address - Fax:
Practice Address - Street 1:14 BROOKFIELD AVE
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-2219
Practice Address - Country:US
Practice Address - Phone:631-294-1749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0990931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical