Healthcare Provider Details

I. General information

NPI: 1639463649
Provider Name (Legal Business Name): DANIELLE MARIE MEROLLA PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 JONES ST STE 200
SETAUKET NY
11733-2941
US

IV. Provider business mailing address

28 JONES ST STE 200
SETAUKET NY
11733-2941
US

V. Phone/Fax

Practice location:
  • Phone: 516-633-2938
  • Fax:
Mailing address:
  • Phone: 516-633-2938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019796
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: