Provider Demographics
NPI:1902120215
Name:MORENO, MELISSA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:FISCHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:400 STONY BROOK CT STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-6522
Mailing Address - Country:US
Mailing Address - Phone:845-665-1234
Mailing Address - Fax:845-733-1910
Practice Address - Street 1:400 STONY BROOK CT STE 1
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-6522
Practice Address - Country:US
Practice Address - Phone:845-565-0600
Practice Address - Fax:845-733-1910
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X, 104100000X
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health