Provider Demographics
NPI:1841588894
Name:MARCELLINO, MELISSA G (LMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:G
Last Name:MARCELLINO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:G
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCMHC
Mailing Address - Street 1:174 HOSPITAL LOOP
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9105
Mailing Address - Country:US
Mailing Address - Phone:802-479-4083
Mailing Address - Fax:802-476-1476
Practice Address - Street 1:174 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9105
Practice Address - Country:US
Practice Address - Phone:802-479-4083
Practice Address - Fax:802-476-1476
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0074983101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019322Medicaid