Healthcare Provider Details

I. General information

NPI: 1942419197
Provider Name (Legal Business Name): MELILLO CENTER FOR MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GLEN COVE AVE
GLEN COVE NY
11542-3438
US

IV. Provider business mailing address

113 GLEN COVE AVE
GLEN COVE NY
11542-3438
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-2388
  • Fax: 516-759-5240
Mailing address:
  • Phone: 516-676-2388
  • Fax: 516-759-5240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6804471A
License Number StateNY

VIII. Authorized Official

Name: DR. DANIEL J. VOGRIN
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 516-676-2388