Provider Demographics
NPI:1962043372
Name:MELISSA M. MARCIANO
Entity Type:Organization
Organization Name:MELISSA M. MARCIANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-564-3667
Mailing Address - Street 1:5444 PARK BLVD N STE 206
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3300
Mailing Address - Country:US
Mailing Address - Phone:727-564-3667
Mailing Address - Fax:
Practice Address - Street 1:5444 PARK BLVD N STE 206
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3300
Practice Address - Country:US
Practice Address - Phone:727-564-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty