Provider Demographics
NPI:1053668681
Name:EDELMAYER, MELISSA L (MSW, LISW-S, LICDC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:EDELMAYER
Suffix:
Gender:F
Credentials:MSW, LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 OFFICENTER PL STE 160
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5352
Mailing Address - Country:US
Mailing Address - Phone:614-664-3595
Mailing Address - Fax:614-664-3595
Practice Address - Street 1:540 OFFICENTER PL
Practice Address - Street 2:SUITE 270
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5317
Practice Address - Country:US
Practice Address - Phone:614-664-3595
Practice Address - Fax:614-664-3595
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161327101YA0400X
OHI.1000341.SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)