Provider Demographics
NPI:1912268061
Name:CAROZZA, MELLISSA (MS SPED)
Entity type:Individual
Prefix:
First Name:MELLISSA
Middle Name:
Last Name:CAROZZA
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MOCCASIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3010
Mailing Address - Country:US
Mailing Address - Phone:845-440-7178
Mailing Address - Fax:
Practice Address - Street 1:45 MOCCASIN VIEW RD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3010
Practice Address - Country:US
Practice Address - Phone:845-440-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1701965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist