Provider Demographics
NPI:1326209966
Name:SOSSICH, MELISSA I (LMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:I
Last Name:SOSSICH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-0790
Mailing Address - Country:US
Mailing Address - Phone:631-790-3753
Mailing Address - Fax:
Practice Address - Street 1:170 LITTLE EAST NECK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7742
Practice Address - Country:US
Practice Address - Phone:631-790-3753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health