Provider Demographics
NPI:1427668946
Name:MELENDEZ, NORMA IVETTE (MFT)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:IVETTE
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARTH DR
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7421
Mailing Address - Country:US
Mailing Address - Phone:646-416-4273
Mailing Address - Fax:
Practice Address - Street 1:4 HARTH DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7421
Practice Address - Country:US
Practice Address - Phone:646-416-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP104387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY143031130OtherDRIVERS LICENSE