1912425679 NPI number — MS. MELINDA MICHELLE STERN LCSW

Table of content: MS. MELINDA MICHELLE STERN LCSW (NPI 1912425679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912425679 NPI number — MS. MELINDA MICHELLE STERN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STERN
Provider First Name:
MELINDA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912425679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 57
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORIARTY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87035-0057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-226-1523
Provider Business Mailing Address Fax Number:
505-521-5191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1709 MOON ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87112-3935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-818-9758
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2017

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:  C-11079 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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