Healthcare Provider Details

I. General information

NPI: 1770908295
Provider Name (Legal Business Name): MELISSA GEORGE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S OYSTER BAY RD
HICKSVILLE NY
11801-3510
US

IV. Provider business mailing address

100 BANKS AVE APT 1264
ROCKVILLE CENTRE NY
11570-3939
US

V. Phone/Fax

Practice location:
  • Phone: 516-822-6111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number72 090551
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number72 090551
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number72 090551
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number72 090551
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number72 090551
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number72 090551
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number72 090551
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number72 090551
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number72 090551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: