Provider Demographics
NPI:1548003460
Name:LAFLEUR, MELLIAN (LMSW)
Entity type:Individual
Prefix:
First Name:MELLIAN
Middle Name:
Last Name:LAFLEUR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4139
Mailing Address - Country:US
Mailing Address - Phone:516-851-9898
Mailing Address - Fax:
Practice Address - Street 1:190 S BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4139
Practice Address - Country:US
Practice Address - Phone:516-851-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional