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

Table of content: (NPI 1871103242)

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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