Provider Demographics
NPI:1619776812
Name:SORRENTINO, MELISSA JASMIN (MHC-LP)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JASMIN
Last Name:SORRENTINO
Suffix:
Gender:
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3509
Mailing Address - Country:US
Mailing Address - Phone:631-310-3157
Mailing Address - Fax:
Practice Address - Street 1:1777 VETERANS MEMORIAL HWY STE 14
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1555
Practice Address - Country:US
Practice Address - Phone:631-630-6439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP133909101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health