Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 017171 | NY |
N | 103TC0700X | Clinical Psychologist | 017171 | NY |
Y | 103G00000X | Clinical Psychologist | 11247 | MA |
Y | 103TC0700X | Clinical Psychologist | 11247 | MA |
NPI | 1003402934 |
---|---|
Provider Name | Melanie F Podsiadlo |
First Address | New Marlborough, MA 01230-9744 |
Second Address | New Marlborough, MA 01230-9744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2020 |
Last Update Date | 15/12/2020 |