Provider Demographics
NPI:1285843482
Name:DAVIS, MELITA J (LISW)
Entity Type:Individual
Prefix:MRS
First Name:MELITA
Middle Name:J
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:MELITA
Other - Middle Name:J
Other - Last Name:KEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW-S
Mailing Address - Street 1:18660 BAGLEY RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3483
Mailing Address - Country:US
Mailing Address - Phone:440-234-8746
Mailing Address - Fax:440-234-8748
Practice Address - Street 1:18660 BAGLEY RD BLDG 1
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3483
Practice Address - Country:US
Practice Address - Phone:440-234-8746
Practice Address - Fax:440-234-8748
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS31392101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH230370Medicare PIN