Provider Demographics
NPI:1609392661
Name:HEUSINGER, MELISSA R (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:R
Last Name:HEUSINGER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3353 BETHFORD DR
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2249
Mailing Address - Country:US
Mailing Address - Phone:716-517-1945
Mailing Address - Fax:
Practice Address - Street 1:3353 BETHFORD DR
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-2249
Practice Address - Country:US
Practice Address - Phone:716-517-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY092378-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor