Healthcare Provider Details

I. General information

NPI: 1245551068
Provider Name (Legal Business Name): MARISSA MENDELSOHN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1792 OLD MILL RD
MERRICK NY
11566-1508
US

IV. Provider business mailing address

1792 OLD MILL RD
NORTH MERRICK NY
11566-1508
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-3398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: