Provider Demographics
NPI:1477741809
Name:MIELLO, MICHAEL J (PH D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MIELLO
Suffix:
Gender:M
Credentials:PH D
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Other - Credentials:
Mailing Address - Street 1:1392 ALBANY POST RD
Mailing Address - Street 2:STE 2E
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-1560
Mailing Address - Country:US
Mailing Address - Phone:914-996-7328
Mailing Address - Fax:
Practice Address - Street 1:1392 ALBANY POST RD
Practice Address - Street 2:STE 2E
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-1560
Practice Address - Country:US
Practice Address - Phone:914-996-7328
Practice Address - Fax:914-221-0891
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2021-08-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY017376103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical