Provider Demographics
NPI:1730370370
Name:ANDERSON, MELISSA A (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1574 REGENT ST
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-4217
Mailing Address - Country:US
Mailing Address - Phone:401-256-4049
Mailing Address - Fax:
Practice Address - Street 1:1574 REGENT ST
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-4217
Practice Address - Country:US
Practice Address - Phone:401-256-4049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019711041C0700X
NY0774831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMS67902Medicaid
RIMS67902Medicaid