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General NPI Number Information
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NPI Number | 1518471325
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Entity Type | Individual
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Provider Name | DAVID MARK MELILLO LPC
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Gender | Male
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 48 E MAIN ST
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City | CLINTON
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State | CT
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Zip | 06413-2035
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Country | US
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Telephone | 860-664-1158
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Fax |
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Provider Business Mailing Address
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Address Line | 135 MIRROR LN
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City | GUILFORD
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State | CT
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Zip | 06437-1941
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Country | US
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Telephone | 203-458-3054
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Fax | 203-245-6098
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 000458
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License Number State | CT
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