Individual
MR. ANTHONY MARK MELILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW,LICSW
Contact information
Practice address
504 MAIN ST, BENNINGTON, VT 05201-2111
(413) 446-4210
Mailing address
23 BRADLEY STREET, ANTHONY M MELILLO, NORTH ADAMS, MA 01247
(413) 446-4210
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
04-PE-AOOOAJ9
WI
1041C0700X
Clinical Social Worker
Primary
089-0001010
VT
1041C0700X
Clinical Social Worker
1024625
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011283
—
VT
01
—
CBH1057539
CIGNA BEHAVIORAL HEALTH
VT
Enumeration date
03/05/2007
Last updated
07/09/2007
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