Healthcare Provider Details

I. General information

NPI: 1487546974
Provider Name (Legal Business Name): MELISSA ANNE CUOCO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 COPPERFIELD DR
WATERFORD NY
12188-1095
US

IV. Provider business mailing address

53 COPPERFIELD DR
WATERFORD NY
12188-1095
US

V. Phone/Fax

Practice location:
  • Phone: 518-727-4451
  • Fax:
Mailing address:
  • Phone: 518-727-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number094647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: