Provider Demographics
NPI:1386424604
Name:CANASTRA, MELANIE GRACE (LMHC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:GRACE
Last Name:CANASTRA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 HIMROD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4405
Mailing Address - Country:US
Mailing Address - Phone:347-484-1473
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 806
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8128
Practice Address - Country:US
Practice Address - Phone:646-449-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health