Healthcare Provider Details

I. General information

NPI: 1508662065
Provider Name (Legal Business Name): GABRIELA MELILLO, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 NEW LOUDON RD
LATHAM NY
12110-6101
US

IV. Provider business mailing address

839 NEW LOUDON RD
LATHAM NY
12110-6101
US

V. Phone/Fax

Practice location:
  • Phone: 518-217-2751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA MELILLO
Title or Position: OWNER
Credential:
Phone: 914-960-8166