Provider Demographics
NPI:1144396045
Name:MCCARDLE, MELISSA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANN
Last Name:MCCARDLE
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 1:220 S SERVICE RD
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2129
Mailing Address - Country:US
Mailing Address - Phone:516-780-5989
Mailing Address - Fax:
Practice Address - Street 1:220 S SERVICE RD
Practice Address - Street 2:SUITE 16
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2129
Practice Address - Country:US
Practice Address - Phone:516-780-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070513-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNB8781Medicare ID - Type UnspecifiedPROVIDER NUMBER