Provider Demographics
NPI:1366695421
Name:RADEN, MELISSA BETH (MS CCC SLP)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:BETH
Last Name:RADEN
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:BETH
Other - Last Name:RADEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:PO BOX 2024
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-0769
Mailing Address - Country:US
Mailing Address - Phone:516-313-7067
Mailing Address - Fax:
Practice Address - Street 1:700 SHORE RD
Practice Address - Street 2:APT.5Y
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4755
Practice Address - Country:US
Practice Address - Phone:516-313-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2008-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009190-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist