Basic Information
| Provider Information | |||||||||
| NPI: | 1124196084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 LENOX AVE | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153639281 | ||||||||
| FaxNumber: | 3153639286 | ||||||||
| Practice Location | |||||||||
| Address1: | 588 BROAD STREET | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153639281 | ||||||||
| FaxNumber: | 3153639286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 0137781 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 06800013778 | 05 | NY | MEDICAID |