Provider Demographics
NPI:1134465214
Name:MELLO, KERRY ANN (MSW)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:MELLO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ORLEANS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1767
Mailing Address - Country:US
Mailing Address - Phone:517-279-8404
Mailing Address - Fax:517-279-8172
Practice Address - Street 1:200 ORLEANS BLVD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1767
Practice Address - Country:US
Practice Address - Phone:517-279-8404
Practice Address - Fax:517-279-8172
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010854371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical