Provider Demographics
NPI:1083470249
Name:MUSTACCHIA, MELISSA (CASAC-T)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MUSTACCHIA
Suffix:
Gender:
Credentials:CASAC-T
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:NUNZIATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASAC-T
Mailing Address - Street 1:398 LEVERETT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-1333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2525
Practice Address - Country:US
Practice Address - Phone:718-981-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)