Provider Demographics
NPI:1063298131
Name:MEALIE, IAN CONOR (MHC, CASAC-T)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:CONOR
Last Name:MEALIE
Suffix:
Gender:M
Credentials:MHC, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2629
Mailing Address - Country:US
Mailing Address - Phone:631-766-1056
Mailing Address - Fax:
Practice Address - Street 1:33 HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2629
Practice Address - Country:US
Practice Address - Phone:631-766-1056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health