Provider Demographics
NPI:1447405154
Name:MARCOLINI, MELISSA (MA,SLP,CCC)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MARCOLINI
Suffix:
Gender:F
Credentials:MA,SLP,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 NO BLVD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-627-3036
Mailing Address - Fax:516-627-6741
Practice Address - Street 1:1165 NO BLVD
Practice Address - Street 2:SUITE 403
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-627-3036
Practice Address - Fax:516-627-6741
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9794-1235Z00000X
009794-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist