Provider Demographics
NPI:1114637154
Name:GALLOWAY, MELANIE LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:LEE
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:LEE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1120 ROUTE 73 STE 300
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5113
Mailing Address - Country:US
Mailing Address - Phone:800-442-8938
Mailing Address - Fax:
Practice Address - Street 1:1320 CENTRAL PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4953
Practice Address - Country:US
Practice Address - Phone:856-288-2539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040132471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical