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General NPI Number Information
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NPI Number | 1023561321
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Entity Type | Individual
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Provider Name | MELISSA CICCARELLO
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Gender | Female
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 265 N RICHMOND AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-3230
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Country | US
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Telephone | 516-652-7625
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 SUNRISE HIGHWAY UNIT 50 #1015
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City | MASSAPEQUA
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State | NY
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Zip | 11758-3230
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Country | US
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Telephone | 516-652-7625
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R083242
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 083242
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License Number State | NY
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