Provider Demographics
NPI:1578900650
Name:CITRON, MELISSA BROOKE (LPC, LMHC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BROOKE
Last Name:CITRON
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:CITRON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LMHC
Mailing Address - Street 1:PO BOX 1374
Mailing Address - Street 2:
Mailing Address - City:BOLTON LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:12814-1374
Mailing Address - Country:US
Mailing Address - Phone:551-579-4410
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1374
Practice Address - Street 2:
Practice Address - City:BOLTON LANDING
Practice Address - State:NY
Practice Address - Zip Code:12814-1374
Practice Address - Country:US
Practice Address - Phone:551-579-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023701OtherAGENCY MEDICAID PROVIDER#
NJ7794703OtherAGENCY PROGRAM MEDICAID PROVIDER #