Healthcare Provider Details

I. General information

NPI: 1831487560
Provider Name (Legal Business Name): MELISSA L MCCORMICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PARSONS BLVD
FLUSHING NY
11355-2205
US

IV. Provider business mailing address

4500 PARSONS BLVD
FLUSHING NY
11355-2205
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-5078
  • Fax:
Mailing address:
  • Phone: 718-670-5078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number083898
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149026117
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: