Individual
MELISSA REVELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6207 WOODSIDE AVE, 4TH FLOOR, WOODSIDE, NY 11377-3576
(718) 898-5085
(718) 898-5582
Mailing address
6207 WOODSIDE AVE, 4TH FLOOR, WOODSIDE, NY 11377-3576
(718) 898-5085
(718) 898-5582
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
095354
NY
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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