Individual ProviderMarybeth MelendezCounselorBehavioral Health & Social Service ProvidersPractice Address374 Manor Road Ste 1, Staten Island, NY 10314(718) 840-8280PECOS EnrollmentBased on the most recent information from CMS, provider Marybeth Melendez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 1:08 PM.Profile DetailsProvider ID1417552175Provider TypeIndividualFull NameMelendez, MarybethCredentialLCMHCGenderFemaleSole ProprietorYesEnumeration Date12/1/2020Last Updated6/28/2021Contact InformationPractice LocationPractice Address374 Manor Road Ste 1, Staten Island, NY 10314Phone(718) 840-8280Fax(718) 987-4061Mailing LocationMailing Address374 Manor Road Ste 1, Staten Island, NY 10314Phone(718) 840-8280Fax(718) 987-4061Provider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense010766-01New York