MEDICARE: MS. JODI MICHELE MERLINO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	068819-1	NY
2	1041C0700X	Clinical Social Worker	085757	NY

General Provider Information

NPI Number	:	1497188353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JODI MICHELE MERLINO LCSW

Provider Business Mailing Address
First Line	:	2305 MOTOR PKWY
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-4724
Country	:	US
Telephone Number	:	631-384-1504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 MOTOR PKWY
Second Line	:
City	:	RONKONKOMA
State	:	NY
Zip	:	11779-4724
Country	:	US
Telephone Number	:	631-384-1504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	11/15/2022

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