Provider Demographics
NPI:1720878390
Name:CALVACHE, MELANIE ALICE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ALICE
Last Name:CALVACHE
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 1:5815 43RD AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4864
Mailing Address - Country:US
Mailing Address - Phone:347-664-9513
Mailing Address - Fax:
Practice Address - Street 1:5815 43RD AVE APT 1D
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4864
Practice Address - Country:US
Practice Address - Phone:347-664-9513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician