Provider Demographics
NPI:1033480744
Name:CLANCY-SCHIFILLITI, MELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELLA
Middle Name:
Last Name:CLANCY-SCHIFILLITI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4905
Mailing Address - Country:US
Mailing Address - Phone:917-940-9980
Mailing Address - Fax:
Practice Address - Street 1:150 BROADHOLLOW RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4905
Practice Address - Country:US
Practice Address - Phone:917-940-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0717451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY071745OtherLCSW