1982067492 NPI number — MR. MELECH DAVID MANN MSW LISW EMDR

Table of content: MR. MELECH DAVID MANN MSW LISW EMDR (NPI 1982067492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982067492 NPI number — MR. MELECH DAVID MANN MSW LISW EMDR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANN
Provider First Name:
MELECH
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW LISW EMDR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANN
Provider Other First Name:
MELECH
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW LISW EMDR
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1982067492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1032 BAY 24TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAR ROCKAWAY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11691-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
929-278-0537
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1032 BAY 24TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
929-278-0537
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I.1800934 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 095443 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 095443 . This is a "NEW YORK STATE BOARD OF CERTIFIED SOCIAL WORKERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: I.1800934 . This is a "NATIONAL ASSOCIATION OF SOCIAL WORK (NASW)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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