Provider Demographics
NPI:1790089142
Name:MELITO, BARBARA MARY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:MARY
Last Name:MELITO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 GREENPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-3725
Mailing Address - Country:US
Mailing Address - Phone:631-942-8215
Mailing Address - Fax:
Practice Address - Street 1:650 UDALL RD
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2117
Practice Address - Country:US
Practice Address - Phone:631-422-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073521-1101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool