Individual
MELISSA FUKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
334 W STATE ST, ITHACA, NY 14850-5432
(607) 273-5500
(607) 273-1277
Mailing address
334 W STATE ST, PO BOX 789, ITHACA, NY 14850-5432
(607) 273-5500
(607) 273-1277
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
079789-1
NY
Other
Enumeration date
10/20/2010
Last updated
11/02/2010
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