Provider Demographics
NPI:1023360708
Name:PIERCE, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PIERCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 STATE ROAD 580
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3167
Mailing Address - Country:US
Mailing Address - Phone:727-733-6111
Mailing Address - Fax:727-733-6002
Practice Address - Street 1:2655 STATE ROAD 580
Practice Address - Street 2:SUITE 202
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3167
Practice Address - Country:US
Practice Address - Phone:727-733-6111
Practice Address - Fax:727-733-6002
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW61341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical