Provider Demographics
NPI:1003379140
Name:CLARKE, MELONIE (LMSW)
Entity Type:Individual
Prefix:
First Name:MELONIE
Middle Name:
Last Name:CLARKE
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 1:36 S CHARLES ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3121
Mailing Address - Country:US
Mailing Address - Phone:443-675-7295
Mailing Address - Fax:
Practice Address - Street 1:36 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3020
Practice Address - Country:US
Practice Address - Phone:410-807-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-06
Last Update Date:2022-01-27
Deactivation Date:2020-04-27
Deactivation Code:
Reactivation Date:2022-01-13
Provider Licenses
StateLicense IDTaxonomies
MD22807104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker