Individual
DR. MARK V. MELLINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
680 W END AVE, SUITE 1A, NEW YORK, NY 10025-6815
(212) 864-2436
Mailing address
1155 WARBURTON AVENUE, APT. 9T, YONKERS, NY 10701-1018
(914) 613-4840
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
002093
CT
103TC0700X
Clinical Psychologist
Primary
006704-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00685456
—
NY
01
—
145203000
MIS
NY
Enumeration date
10/29/2005
Last updated
01/27/2011
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