Healthcare Provider Details

I. General information

NPI: 1548478464
Provider Name (Legal Business Name): MELILLO CENTER FOR MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 GLEN COVE RD
GLEN HEAD NY
11545-2233
US

IV. Provider business mailing address

113 GLEN COVE AVE
GLEN COVE NY
11542-3438
US

V. Phone/Fax

Practice location:
  • Phone: 516-676-1863
  • Fax: 516-759-5259
Mailing address:
  • Phone: 516-676-2388
  • Fax: 516-759-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6804430
License Number StateNY

VIII. Authorized Official

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