| Willow Tree Counseling Lcsw, Pc | |
|
2305 Motor Pkwy Ronkonkoma NY 11779-4724 | |
| (631) 384-1504 | |
| Not Available |
| Full Name | Willow Tree Counseling Lcsw, Pc |
|---|---|
| Speciality | Social Worker |
| Location | 2305 Motor Pkwy, Ronkonkoma, New York |
| Authorized Official Name and Position | Jodi Michele Merlino (OWNER) |
| Authorized Official Contact | 6313841504 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Tree Counseling Lcsw, Pc 2305 Motor Pkwy Ronkonkoma NY 11779-4724 Ph: (631) 384-1504 | Willow Tree Counseling Lcsw, Pc 2305 Motor Pkwy Ronkonkoma NY 11779-4724 Ph: (631) 384-1504 |
| NPI Number | 1639879810 |
|---|---|
| Provider Enumeration Date | 03/07/2023 |
| Last Update Date | 03/07/2023 |
| Certification Date | 03/07/2023 |
| Medicare PECOS PAC ID | 0547625162 |
|---|---|
| Medicare Enrollment ID | O20230503001350 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639879810 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jodi Michele Merlino |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497188353 PECOS PAC ID: 9638534266 Enrollment ID: I20230503001721 |
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