Provider Demographics
NPI:1013979202
Name:MECCARELLO, JON C (PHD,)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:C
Last Name:MECCARELLO
Suffix:
Gender:M
Credentials:PHD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EAST AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1646
Mailing Address - Country:US
Mailing Address - Phone:585-734-2679
Mailing Address - Fax:
Practice Address - Street 1:1400 EAST AVE APT 301
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1646
Practice Address - Country:US
Practice Address - Phone:585-734-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical