Individual
MRS. MELISSA ANN TILLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
2174 HEWLETT AVE, MERRICK, NY 11566-3606
(516) 858-2877
Mailing address
1859 LEONARD LN, MERRICK, NY 11566-4933
(516) 721-7694
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
020158
NY
103TC0700X
Clinical Psychologist
20158
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00745088
AGENCY'S MEDICAID MMIS #
NY
01
—
1003991019
AGENCY'S NPI #
NY
Enumeration date
10/08/2010
Last updated
06/11/2019
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