Provider Demographics
NPI:1851815120
Name:ULLOA, MELISSA (MA, LCAT, LP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ULLOA
Suffix:
Gender:F
Credentials:MA, LCAT, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WYCKOFF AVE, 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-5842
Mailing Address - Country:US
Mailing Address - Phone:718-497-6090
Mailing Address - Fax:718-497-9495
Practice Address - Street 1:315 WYCKOFF AVE, 6TH FLOOR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5842
Practice Address - Country:US
Practice Address - Phone:718-497-6090
Practice Address - Fax:718-497-9495
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP07324101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor