Provider Demographics
NPI:1518471325
Name:MELILLO, DAVID MARK (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARK
Last Name:MELILLO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MIRROR LN
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1941
Mailing Address - Country:US
Mailing Address - Phone:203-458-3054
Mailing Address - Fax:203-245-6098
Practice Address - Street 1:48 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-2035
Practice Address - Country:US
Practice Address - Phone:860-664-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional