Provider Demographics
NPI:1245815653
Name:CANNO-VELEZ, MELINDA PAIGE (MSW)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:PAIGE
Last Name:CANNO-VELEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 UPPER SHAD RD
Mailing Address - Street 2:
Mailing Address - City:POUND RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10576-2107
Mailing Address - Country:US
Mailing Address - Phone:914-450-4211
Mailing Address - Fax:
Practice Address - Street 1:49 UPPER SHAD RD
Practice Address - Street 2:
Practice Address - City:POUND RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10576-2107
Practice Address - Country:US
Practice Address - Phone:914-450-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049500-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker