Provider Demographics
NPI:1427451186
Name:WILDING, MELODY (LMSW)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:WILDING
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 1:3 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-3001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E 86TH ST
Practice Address - Street 2:3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4711
Practice Address - Country:US
Practice Address - Phone:862-221-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker