Provider Demographics
NPI:1033851761
Name:MELLO, WILLIAM B JR (LMSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:MELLO
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 N LAKEHARBOR LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6913
Mailing Address - Country:US
Mailing Address - Phone:208-991-4296
Mailing Address - Fax:
Practice Address - Street 1:3649 N LAKEHARBOR LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6913
Practice Address - Country:US
Practice Address - Phone:208-991-4296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-408571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical