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General NPI Number Information
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NPI Number | 1225167984
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Entity Type | Individual
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Provider Name | ANTHONY MARK MELILLO MSW,LICSW
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 504 MAIN ST
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City | BENNINGTON
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State | VT
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Zip | 05201-2111
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Country | US
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Telephone | 413-446-4210
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Fax |
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Provider Business Mailing Address
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Address Line | 23 BRADLEY STREET ANTHONY M MELILLO
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City | NORTH ADAMS
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State | MA
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Zip | 01247
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Country | US
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Telephone | 413-446-4210
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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 | 089-0001010
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License Number State | VT
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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 | 1024625
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 04-PE-AOOOAJ9
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License Number State | WI
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