Provider Demographics
NPI:1346021953
Name:MELVIN, CRISTINA MARIA (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:MARIA
Last Name:MELVIN
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 PLAZA DR STE 301
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5508
Mailing Address - Country:US
Mailing Address - Phone:728-630-1744
Mailing Address - Fax:
Practice Address - Street 1:414 PLAZA DR STE 301
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-5508
Practice Address - Country:US
Practice Address - Phone:728-630-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker