Provider Demographics
NPI:1699082024
Name:MARELLI, MELISSA ELIZABETH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:MARELLI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MALBA
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1002
Mailing Address - Country:US
Mailing Address - Phone:718-746-1610
Mailing Address - Fax:
Practice Address - Street 1:17 BOULEVARD
Practice Address - Street 2:
Practice Address - City:MALBA
Practice Address - State:NY
Practice Address - Zip Code:11357-1002
Practice Address - Country:US
Practice Address - Phone:718-746-1610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018817-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist