Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 050395-1-R | NY |
NPI | 1003126210 |
---|---|
Provider Name | Dr. Michelle Memoli |
First Address | Scarsdale, NY 10583-2801 |
Second Address | Scarsdale, NY 10583-2801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2010 |
Last Update Date | 21/10/2010 |