Provider Demographics
NPI:1053760439
Name:SCHWENK, MELODY FAITH
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:FAITH
Last Name:SCHWENK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 GRANGE LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1608
Mailing Address - Country:US
Mailing Address - Phone:917-275-5417
Mailing Address - Fax:
Practice Address - Street 1:23 GRANGE LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1608
Practice Address - Country:US
Practice Address - Phone:917-275-5417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst