Provider Demographics
NPI:1750174322
Name:LIN DE LA ROSA ORTEGA, MELISSA GRACE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:LIN DE LA ROSA ORTEGA
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 1:635 W 59TH ST APT 1911
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-0115
Mailing Address - Country:US
Mailing Address - Phone:347-334-1158
Mailing Address - Fax:
Practice Address - Street 1:635 W 59TH ST APT 1911
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-0115
Practice Address - Country:US
Practice Address - Phone:347-334-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1901445251103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty