Individual provider Active NPI

Melissa Tully

  • Social Worker
  • Valhalla, NY
National Provider Identifier
1386040152
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
License
096765 Issued in NY
Practice address
503 Grasslands Rd
Valhalla, NY 10595-1503
Phone
(914) 593-0593
NPI assigned
Nov 6, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Social Worker 104100000X 096765 NY Primary

Addresses

Primary practice location

503 Grasslands Rd
Valhalla, NY 10595-1503

Mailing address

503 Grasslands Rd
Valhalla, NY 10595-1503
Phone (914) 593-0593

Other practice location 1

9 W Prospect Ave
Suite 412
Mount Vernon, NY 10550-2018
Phone (914) 665-6641

Other practice location 2

9 W Prospect Ave
Suite 412
Mount Vernon, NY 10550-2018
Phone (914) 665-6641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
096765NYMDSocial Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1386040152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 GRASSLANDS RD",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "105951503",
            "telephone_number": "914-593-0593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 GRASSLANDS RD",
            "city": "VALHALLA",
            "state": "NY",
            "postal_code": "105951503",
            "telephone_number": "914-593-0593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9 W Prospect Ave",
            "address_2": "Suite 412",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "NY",
            "postal_code": "105502018",
            "country_code": "US",
            "telephone_number": "914-665-6641",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9 W Prospect Ave",
            "address_2": "Suite 412",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "NY",
            "postal_code": "105502018",
            "country_code": "US",
            "telephone_number": "914-665-6641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TULLY",
        "first_name": "MELISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-06",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "096765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valhalla, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.